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A recent study by the California Workers' Compensation Institute found that inpatient hospitalizations for workers injured on the job declined 15 percent between 2002 and 2006 -- coinciding with the implementation of the reforms and reductions in the number of work-related injuries.

Using data on nearly 20 million hospital discharges from the California Office of Statewide Health Planning and Development, the CWCI found that injured workers have consistently accounted for less than 1 percent of inpatient hospital stays. While the number of hospitalizations covered by group health, Medicare, MediCal, and other nonworkers' comp plans held steady, researchers said inpatient stays for injured workers fell significantly. The sharpest decline occurred in 2005, after workers' comp medical care became subject to utilization controls, including treatment guidelines, mandatory utilization review, and second opinions for spinal surgery.

Decline in back injuries was key, study finds. Researchers said a steady decline in the number of inpatient discharges for work-related back injuries -- which fell 25 percent from 11,237 cases in 2002 to 8,385 cases in 2006 -- explains much of the overall decline in workers' comp hospitalizations. In contrast, the study found that the number of hospital stays for back injuries covered by nonworkers' comp programs rose 4 percent over the same period. On the other hand, researchers said that even with the reduction in the number of hospital stays for work-related back problems, back diagnoses still accounted for one-third of all California workers' comp inpatient hospitalizations between 2002 and 2006 versus just 1.5 percent of nonworkers' comp hospitalizations.

Breaking down the data by specific diagnostic groups revealed significant differences between workers' comp and other programs in the types of back conditions that resulted in inpatient care. For example, medical back problems (primarily back sprains) accounted for nearly one-third of nonworkers' comp back problems resulting in hospitalization -- almost triple the proportion noted in workers' comp. Focusing on just inpatient hospitalization cases that involved surgery, the study found that one-third of the workers' comp surgical discharges were spinal fusions except cervical, compared to one-quarter of nonworkers' comp surgical discharges. Conversely, researchers said that just under half of the nonworkers' comp surgical discharges were back and neck procedures, while these diagnoses made up about 36 percent of the workers' comp surgical back cases.

Complications less prevalent in comp back surgeries. The study also noted that complications were far less prevalent in the workers' comp back surgeries. This was despite the fact that the average number of surgical procedures used in back cases was similar to other systems, and, for most diagnostic categories, the average number of surgical procedures in both workers' comp and nonworkers' comp cases increased at about the same rate over the five-year study period.

After adjusting the surgical back data to control for differences in the mix of injuries between workers' comp and other systems, the CWCI calculated and compared several variables associated with the intensity of service. The analysis found that, on average, workers' comp surgical back cases involved shorter hospital stays, fewer total procedures, and fewer surgical procedures for most of the study period. However, the average charge per hospital stay was similar to the average charged in other systems.

December 16, 2008

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