California Workers’ Compensation Insurance: Medical Provider Networks Now Account For Over 80% Of Injured Worker Medical Services

The latest data show network providers accounted for 83.1 percent of services in the first 30 days on claims for injuries from the first quarter of AY 2009, and 67.4 percent of the post-30 day services rendered on AY 2008 claims.

(From a CWCI.org release)   A new California Workers’ Compensation Institute (CWCI) study shows the percentage of medical services to injured workers delivered by network physicians jumped sharply immediately after Medical Provider Networks (MPNs) were introduced into the workers’ compensation system in 2005, and that both the network utilization rate and the percentage of workers’ compensation medical dollars paid to network providers have continued to climb over the past five years.

Using first-year medical service data from 891,918 California workers’ compensation claims with 2004-2009 injury dates, CWCI measured the percentage of injured worker outpatient medical services rendered by network providers before and after MPNs began operations in January 2005. The results show that the network utilization rate rose from less than half of first-year physician-based services for 2004 job injuries to nearly 2/3 of the services for 2005 injuries – the first claims in which treatment in the initial 12 months could have shifted to MPNs. Furthermore, the data show that the trend toward the use of networks has continued, with network providers accounting for nearly ¾ of physician-based services for 2008 injury claims.

 http://www.cwci.org/press_release.html?id=164

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