Use of Physician Networks Up in California Workers’ Comp System
The use of medical provider network physicians to treat injured workers increased by nearly 30 percentage points over an 11-year period, but payers' benefits for using such networks have fallen, according to a report released Tuesday by the California Workers' Compensation Institute, Business Insurance reports.
Details of Report
For the report, CWCI reviewed more than 1.8 million claims from 2000 through June 2011 (Goldberg, Business Insurance, 6/11).
The report, which sought to determine the effect of medical provider networks on California's workers' compensation system, compared payments from three time periods:
- The PPO period between 2000 and 2002;
- The medical provider network transition period between 2003 and 2007; and
- The full medical provider network period between 2008 and 2011 (CWCI release, 6/9).
According to the report, the use of network providers in the state's workers' compensation system increased from about 55% of all claims before provider networks were introduced to about 80% after they were fully implemented (Business Insurance, 6/11).
Among indemnity claims, the use of network physicians increased from 44.2% during the PPO period to 77.2% after provider networks were fully implemented (CWCI release, 6/9).
The report found that indemnity claims had lower attorney involvement rates, compared with non-network claims. Still, the attorney involvement rate for indemnity claims increased from 38% during the PPO period to about 45% in the full network period.
Meanwhile, the report showed that network claims had higher closure rates. However, for claims at one year after injury, closure rates fell from 73% in the PPO period to 61% in the full provider network period.
The percentage of claims with opioid prescriptions also increased during the study period, from about 39% in the PPO period to about 55% in the full provider network period.
In a statement, CWCI said, "Overall medical cost savings associated with network-managed claims have dwindled."
The institute added, "Despite the reduction in cost savings associated with network managed claims overall, the study did find considerable variation among individual networks in the study sample, with just as many networks generating lower costs per claim as higher costs per claim when their results were compared to those of claims with non-network" coverage (Business Insurance, 6/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.