workers’ compensation researchtn. va. fl. md. ma. mi. sc. ok. ga. ca. nc. tx. pa. ny. la % of...
TRANSCRIPT
Workers’ Compensation Research
▪ Independent, not-for-profit research organization ▪ Founded in Cambridge MA in 1983 ▪ Diverse membership support ▪ Studies are peer-reviewed ▪ Resource for public officials & stakeholders ▪ Content-rich website: www.wcrinet.org ▪ Over 500 WC studies published
About WCRI
2 © Copyright 2015 WCRI. All Rights Reserved.
▪ Mission “Be a catalyst for improving WC systems by providing the public with high-quality, credible information on important public policy issues.”
▪ Studies focus on benefit delivery system ▪ Does not make recommendations nor take positions
on issues
WCRI Approach
3 © Copyright 2015 WCRI. All Rights Reserved.
▪ How states compare ▪ Income benefit payments
▪ Worker outcomes
▪ Medical costs and care delivered
▪ Long-term opioid use
▪ Physician dispensing of Rx ▪ Trust in the workplace and worker outcomes ▪ Provider responses to medical price regulation
Outline: Illustrations Of Available Information
4 © Copyright 2015 WCRI. All Rights Reserved.
Wisconsin Indemnity Payments/Claim 39% Lower Than The Median State
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
IN TX WI NJ FL AR MI MN VA MA CA IL IA PA LA GA NC
Aver
age
Inde
mni
ty P
aym
ent/
Clai
m
$10,847
Median State: $17,670
5 © Copyright 2015 WCRI. All Rights Reserved.
2011/14 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix And Wages; Source: CompScope™ Benchmarks For Wisconsin, 15th Edition (2015).
WI Workers Achieve Better Outcomes
Outcome Wisconsin Median State
RTW: Not Working At Interview (%) 12% 13%
Median Duration Of Disability (Weeks) 9 weeks 10 weeks
Access: % Reported “Big Problems” Getting Desired Care 10% 16%
Satisfaction: % Reported “Very Dissatisfied” With Care 9% 13%
Earning A Lot Less At Interview (%) 6% 8%
6
* Statistically Significant
© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin Medical Payments Per Claim 40% Higher Than Typical
$0
$5,000
$10,000
$15,000
$20,000
MA CA MI TX MN AR FL NC PA LA IL IA NJ VA WI IN
Aver
age
Med
ical
Pay
men
t/Cl
aim
$16,980 Median: $12,167
7 © Copyright 2015 WCRI. All Rights Reserved.
2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).
WI Medical Payments Higher And Have Grown Rapidly
8 © Copyright 2015 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix And Wages; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Aver
age
Med
ical
Pay
men
t/Cl
aim
Wisconsin
Other Study States
AAPC 2007/08 To 2012/13 WI: 6.5% Median Study State: 4.5%
0
50
100
150
200
250
FL CA SC NC NY OK MI MD PA MA AR TN LA AZ TX MN GA CT VA IA IL MO NJ IN WI
25-S
tate
Med
ian
= 10
0 Nonhospital Prices Paid In Wisconsin Were The Highest Of 25 States
9
Prices Paid For Nonhospital Services Rendered In 2013 (January Through June) Source: WCRI Medical Price Index For Workers’ Compensation, Sixth Edition (2014)
States With Fee Schedule No Fee Schedule
© Copyright 2015 WCRI. All Rights Reserved.
Payments Per Claim In WI For Key Nonhospital Services 26%–265% Higher
Payments/Claim For Nonhospital Services Wisconsin 16-State
Median %
Difference Pain Mgmt. Injections $1,853 $508 265% Major Surgery $7,692 $2,595 196% Minor Radiology $421 $171 147% Major Radiology $1,649 $832 98% Evaluation And Mgmt. $1,071 $751 43% Physical Medicine $3,814 $3,029 26%
10
2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScope™ Medical Benchmarks For Wisconsin, 15th Edition (2014).
© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin WC Paid Much Higher Prices Than Group Health For Knee Arthroscopy
11
Group Health Data Include Copays And Deductibles. Source: A New Benchmark For Workers’ Compensation Fee Schedules: Prices Paid By Commercial Insurers? (2013)
$3,728
$1,573
$0$500
$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500
MI* AR FL TX MD NC LA
TN* GA PA CA
OK* VA IA NY
MA AZ CT* WI
IN IL* NJ
Median WC Price Paid Median GH Price Paid
WC
And
GH
Med
ian
Pric
es P
aid,
20
09 (C
PT 2
9881
)
* MI, OK, TN, CT, and IL implemented a double-digit fee schedule decrease for a common knee arthroscopy (CPT 29881) from 2009 to 2012.
© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin Average Morphine Equivalent Amount Per Claim Lower Than Typical
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
MO IA WI NJ IN MN AR CT FL IL KS TN VA MI GA TX CA SC MD NC MA OK PA NY LA
Avg.
MEA
/Cla
im W
ith N
arco
tics
(mill
igra
ms)
Median: 1,861 mg
12
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, Prescriptions Filled Through March 2012 Source: Interstate Variations In Use Of Narcotics, 2nd Edition (2014)
© Copyright 2015 WCRI. All Rights Reserved.
WI % Workers Who Were Longer-Term Users Of Opioids Lowest Of Study States
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
WI IN NJ MO IA AR KS MN CT IL TN VA FL MD MA MI SC OK GA CA NC TX PA NY LA
% O
f Cla
ims
With
Opi
oids
Iden
tifie
d
As L
onge
r-Ter
m U
sers
Of O
pioi
ds Median: 7%
4%
13
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, Prescriptions Filled Through March 2012 Source: Longer-Term Use Of Opioids, 2nd Edition (2014)
© Copyright 2015 WCRI. All Rights Reserved.
▪ Income benefits ▪ Worker outcomes ▪ Medical costs ▪ Medical price indices ▪ Nature of care (e.g., surgery rates, opioid use) ▪ Litigiousness and litigation costs ▪ Medical cost containment expenses ▪ Timely payment to worker
Benchmark Metrics
14 © Copyright 2015 WCRI. All Rights Reserved.
▪ Impact of state reforms ▪ Physician dispensing ▪ Medical treatment guidelines/utilization review ▪ Effect of ACA on WC systems ▪ Medical price regulation ▪ Compounding of Rx medications ▪ Impact of provider choice laws
Topical Studies—Examples
15 © Copyright 2015 WCRI. All Rights Reserved.
▪ How states compare ▪ Income benefit payments
▪ Worker outcomes
▪ Medical costs and care delivered
▪ Long-term opioid use
Physician dispensing of Rx Trust in the workplace and worker outcomes ▪ Provider responses to medical price regulation
Outline: Illustrations Of Available Information
16 © Copyright 2015 WCRI. All Rights Reserved.
18 States Changed Rules Governing Reimbursement For Physician-Dispensed Drugs
17 © Copyright 2015 WCRI. All Rights Reserved.
States Where Physician Dispensing Not Allowed In General Or Infrequent
CA
FL
SC
NC
IL
OK
MI
AZ TN
IN
GA MS
CT DE
HI
AL
PA
ID
Reform States Focusing On Price Reduction Only
Reform States Further Limiting Physician Dispensing To Short Timeframe Or Certain Drugs
The Same Drugs, When Physician-Dispensed, Are Much Higher Priced
18
Common WC Drugs Prescribed By Physicians
Price Per Pill %
Difference Physician Rx
Pharmacy Rx
Hydrocodone-acetaminophen (Vicodin®) $1.41 $0.52 172%
Ibuprofen (Motrin®) $0.49 $0.27 81% Tramadol HCL (Ultram®) $1.55 $0.73 114% Cyclobenzaprine HCL (Flexeril®) $1.85 $0.99 88% Meloxicam (Mobic®) $5.86 $3.19 84%
Illinois 2011/12 Claims With > 7 Days Of Lost Time With Prescriptions Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013)
© Copyright 2015 WCRI. All Rights Reserved.
Does Physician Dispensing Increase Opioid Use?
19
Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) © Copyright 2015 WCRI. All Rights Reserved.
3.9%
0.5%
12.2% 14.2%
12.2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Pre-Reform Post-Reform
% O
f Wor
kers
With
Stro
ng O
pioi
ds
Physician Dispensed
Pharmacy Dispensed
*
* Statistically Significant at the 0.01 level
Does Physician Dispensing Increase Opioid Use? Likely
20
3.9%
0.5%
12.2% 14.2%
12.2% 12.5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Pre-Reform Post-Reform
% O
f Wor
kers
With
Stro
ng O
pioi
ds
Physician Dispensed
Pharmacy Dispensed
Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014) © Copyright 2015 WCRI. All Rights Reserved.
* Statistically Significant at the 0.01 level
*
Most Received Physician-Dispensed NSAIDs And Weaker Opioids
9.1% 10.1%
24.1% 25.8%
3.9%
0.5% 0%
5%
10%
15%
20%
25%
30%
Pre-Reform Post-Reform
% O
f Wor
kers
With
Phy
sici
an-
Dis
pens
ed R
x
21 © Copyright 2015 WCRI. All Rights Reserved.
Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014)
NSAIDs
Weaker Opioids
Strong Opioids
*
*
*
* Statistically Significant at the 0.01 level
22 © Copyright 2015 WCRI. All Rights Reserved.
Cyclobenzaprine New Strength In California: Rapid Increase, Much Higher Prices
0%
10%
20%
30%
40%
50%
60%
70%
80%7.5 Milligrams Price Per Pill Paid: $2.90–$3.45
5 Milligrams Price Per Pill Paid: $0.35–$0.59
10 Milligrams Price Per Pill Paid: $0.49–$0.70
23 © Copyright 2015 WCRI. All Rights Reserved.
Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2011 (2011Q1) To First Quarter Of 2013 (2013Q1)
Calendar Quarters
% O
f Pre
scrip
tions
For
Cyc
lobe
nzap
rine
HCL
By
Stre
ngth
Frequent Dispensing Of 7.5-Milligram Product At Much Higher Price Drove Up Physician Price
$0.00
$0.50
$1.00
$1.50
$2.00
$2.50
2010Q1
2010Q2
2010Q3
2010Q4
2011Q1
2011Q2
2011Q3
2011Q4
2012Q1
2012Q2
2012Q3
2012Q4
2013Q1
Physician-Dispensed Rx Pharmacy-Dispensed Rx
24 © Copyright 2015 WCRI. All Rights Reserved.
Calendar Quarters
Aver
age
Pric
e Pe
r Pill
Pai
d Fo
r Cy
clob
enza
prin
e H
CL B
y D
ispe
nsin
g Po
int
Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2010 (2010Q1) To First Quarter Of 2013 (2013Q1)
About The “Fear Of Firing” Predictor
Responses % Of Workers In Survey – WI Strongly Disagree 51% Somewhat Disagree 12% Somewhat Agree 13% Strongly Agree 24%
25
Survey question: When injured, I was afraid of being fired or laid off?
© Copyright 2015 WCRI. All Rights Reserved.
Those Who Strongly Agreed Were Most Likely To Have Worse Outcomes
Outcome Strongly Or Somewhat Disagreed
Strongly Agreed (Fearful)
RTW: Not Working At Interview (%) 10% 21%* Median Duration Of Disability (Weeks) 9 13* Access: % Reported “Big Problems” Getting Desired Care 9% 20%*
Satisfaction: % Reported “Very Dissatisfied” With Care 8% 18%*
Earning A Lot Less At Interview (%) 3% 16%*
26
* Statistically Significant
© Copyright 2015 WCRI. All Rights Reserved.
▪ How states compare ▪ Income benefit payments
▪ Worker outcomes
▪ Medical costs and care delivered
▪ Long-term opioid use
▪ Physician dispensing of Rx ▪ Trust in the workplace and worker outcomes Provider responses to medical price regulation
Outline: Illustrations of Available Information
27 © Copyright 2015 WCRI. All Rights Reserved.
-10
10
30
50
70
90
110
130
150
170
190
CA MA FL NC NY HI PA OK UT MD SD MI
KY WV
CO WY
OH SC KS LA ME VT N
M AR MN AZ MS NE
WA AL TX CT GA TN ND NV
MT
OR DE ID IL AK
WC
Fee
Sche
dule
% A
bove
/Bel
ow
Stat
e M
edic
are
Rate
s, 2
011
In Most States, WC Physician Fee Schedule Above Medicare Rates By 30% Or More
28
Source: Designing Workers’ Compensation Medical Fee Schedules (2012)
© Copyright 2015 WCRI. All Rights Reserved.
Lower Prices Associated With More Frequent Billing Of Complex Office Visits
29 © Copyright 2015 WCRI. All Rights Reserved.
Common Office Visits In Calendar Year 2012 Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
$0$20$40$60$80$100$120$140$160$180$200
0%10%20%30%40%50%60%70%80%90%
100%
IA WI AR TX MI IN MN PA MA VA LA NC IL NJ FL CA
% Of Office Visits Billed As More Complex Average Price—Common Office Visit
% O
f Est
ablis
hed
Patie
nt O
ffice
Vi
sits
Bill
ed A
s M
ore
Com
plex
Average Price Paid For Comm
on Office Visits
Correlation Coefficient: -0.6
CA: Most Office Visits Were “Intermediate” (CPT 99213)
0%
20%
40%
60%
80%
100%
2004
% O
f E&
M S
ervi
ces
For
Est
ablis
hed
Patie
nts
Level 1 Level 2 Level 3 Level 4 Level 5
30 © Copyright 2015 WCRI. All Rights Reserved.
E&M: Evaluation & Management Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
$46
$69
$104
Prices Paid
CA Prices Frozen For 3 Years—More Office Visits Coded As More Expensive
0%
20%
40%
60%
80%
100%
2004 2005 2006
% O
f E&
M S
ervi
ces
For
Est
ablis
hed
Patie
nts
Level 1 Level 2 Level 3 Level 4 Level 5
31 © Copyright 2015 WCRI. All Rights Reserved.
$45
$69
$101
$46
$69
$103
$46
$69
$104
Prices Paid
Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
After CA Raised The Fee Schedule, Upcoding Stopped
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007
% O
f E&
M S
ervi
ces
For
Est
ablis
hed
Patie
nts
Level 1 Level 2 Level 3 Level 4 Level 5
32 © Copyright 2015 WCRI. All Rights Reserved.
$46
$69
$103
$46
$69
$104
Prices Paid
$52
$81
$107
$45
$69
$101
Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
FS Increase
When The Fee Schedule Was Re-Frozen, Upcoding Resumed
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007 2008 2009 2010 2011 2012
99211 99212 99213 99214 99215
33 © Copyright 2015 WCRI. All Rights Reserved.
$104 $103 $107 $113 $101 $116 $116
$69 $69 $81 $84
$69 $84
$83
$46 $46 $52 $54
$45 $54 $54
Prices Paid
$113
$84
$54
Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
FS Increase
$83
$54
$112
% O
f Offi
ce V
isits
For
Es
tabl
ishe
d Pa
tient
s
2003 FL Reforms Reduced Fee Schedule Rates For Many Hospital Outpatient Services
Hospital Outpatient Pre-Reform Post-Reform
Scheduled Radiology 75% of charges 110% Medicare
Unscheduled Radiology 75% of charges 75% of charges
34 © Copyright 2015 WCRI. All Rights Reserved.
Source: CompScope™ Medical Benchmarks For Florida, 15th Edition (2014)
Lumbar MRIs Were Paid More Often As Unscheduled With Higher Rates After 2005
38% 34% 53%
68% 63% 82% 86%
71% 71%
62% 66% 47%
32% 37% 18% 14%
29% 29%
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007 2008 2009 2010 2011 2012
% O
f Lum
bar M
RIs
Don
e In
H
ospi
tal O
utpa
tient
Set
tings
Paid > Nonhospital FS Paid <= Nonhospital FS
35 © Copyright 2015 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix Source: CompScope™ Medical Benchmarks For Florida, 15th Edition (2014)
WCRI Is A Resource For You
For further information: website www.wcrinet.org Richard Victor 617.661.9274
36 © Copyright 2015 WCRI. All Rights Reserved.