Inpatient Hospitalizations in California Workers’ Comp Declined 51%, Study Shows

The number of inpatient hospitalizations in the California workers’ compensation system declined 51.1% between 2012 and 2022, a new report shows.

The trend was driven by declining claim volume, technological advances and changes in Medicare rules that allow more outpatient procedures, the elimination of redundant payments for spinal surgery hardware, and the expansion of evidence-based guidelines for spinal fusions and other surgeries, according to the California Workers’ Compensation Institute analysis.

The CWCI used data on 28.7 million inpatient hospital stays with 2012 through 2022 discharge dates compiled by the California Department of Health Care Access and Information to compare the use of inpatient services and procedures covered by workers’ comp, Medicare, Medi-Cal and private coverage.

The study found that the number of workers’ comp inpatient stays declined from 21,505 in 2012 to 10,516 in 2022, and between 2021 and 2022, the number of workers’ comp hospitalizations declined by 5.6%, bringing the total decline over the past 11 years to 51.1%.

In comparison, the number of hospital stays paid under private coverage fell 23.5% over the same period, while Medicare hospital stays were only down 1.4%, and those paid by Medi-Cal increased by 45.7% due to surging Medi-Cal enrollments following passage of the Affordable Care Act in 2014, according to the CWCI study.

The CWCI analysis notes the decline in the number of workers’ comp inpatient stays dates back more than a decade, fueled by fluctuations in the number and types of work injury claims, the adoption of utilization review and independent medical review programs requiring that treatment meet evidence-based medicine standards, and a sharp reduction in the number of spinal fusions.

The data suggest many of those factors continue to help contain the volume of workers’ comp inpatient stays, as unlike the other systems where inpatient hospitalizations have rebounded after falling sharply in 2020, which was the first year of the pandemic. One exception is inpatient spinal fusions, which were up 5.0% between 2020 to 2022, driving spinal fusion hospital stays back up to 18.7% of all workers’ comp inpatient discharges in 2022, the highest proportion since 2016, according to CWCI.

CWCI issued a Research Update Report on the study, “Utilization of Inpatient Care in California Workers’ Compensation, 2012-2022.” CWCI members and subscribers can access the report and a summary Bulletin at the CWCI website. Others can purchase a copy at the CWCI store.