California Study Examines Medical Access in the Wake of Reforms

A new California Workers’ Compensation Institute (CWCI) study has found that injured worker access to medical-legal and medical care providers changed very little following the enactment of reforms designed to control the utilization and cost of forensic medicine and treatment in the California workers’ compensation system.

Physician groups and applicants’ attorneys have cited anecdotal evidence and physician surveys to assert that workers’ comp medical reforms enacted in recent years have led to an exodus by med-legal providers and treating physicians, making it difficult for injured workers to obtain forensic reports and medical care.

Using data from more than 900,000 California work injury claims from accident years 1993 to 2005, CWCI ran three separate analyses that tracked injured worker access to forensic physicians (med-legal report writers); primary care physicians (family medicine, general practice and occupational medicine providers); and four types of specialists common to workers’ compensation (orthopedists, chiropractors, neurologists/neurosurgeons and internists). Each of the three analyses measured changes in the average distance from an injured worker’s home to the three closest physicians who were active in workers’ compensation at the time services were rendered. The Institute also calculated changes in the proportion of injured workers in California who fell within the access standards of three primary care providers within 15 miles of the worker’s home, as well as three specialty providers and three forensic physicians within 30 miles.

The analysis of access to forensic providers found that after the state adopted the med-legal fee schedule in 1993, injured worker proximity to med-legal report writers improved, as the average distance from an injured worker’s home to the three closest med-legal report writers fell from 2.1 miles in early 1993 to 1.6 miles in 1994. Data from 2004 and 2005 reveal that a decade later, access remained good, with injured workers only needing to travel an average of 1.5 miles to locate three forensic physicians. Furthermore, in both the pre-and post-reform samples, 99 percent of injured workers in the state met the access standard of three forensic physicians within 30 miles of their homes.

To measure pre-reform access to primary care and specialty physicians, CWCI used data from claims occurring in 1996 and 1998, the period following the Minniear decision – case law that expanded the treating physicians’ presumption of correctness and fueled the rapid growth in workers’ comp medical utilization and costs that eventually led to the 2002-2004 medical reforms. Those results were then compared to physician access data from 2004 and 2005 – the initial two years in which the medical reforms were introduced – including mandatory utilization review, medical treatment guidelines, and beginning in 2005, medical provider networks. Injured worker access to three primary care physicians fluctuated little in the pre- and post-reform periods, with the statewide average ranging between 2.7 to 3.2 miles from the injured worker’s home, and throughout all four years of the study, no less than 95 percent of injured workers in the state meeting the access standard of three primary care providers within 15 miles. Likewise, the average distance to a choice of three specialists was well below the state’s 30-mile access standard throughout all of the periods studied, ranging from 2.3 miles in 1998 and 2004 to 3.9 miles in 2005, with 98 to 99 percent of the state’s injured workers within the 30-mile access standard across all years of the study.

Breakouts by county found variations in physician access by region, with the proportion of injured workers meeting the access standards lowest in five sparsely populated rural counties, where health care of any kind tends to be harder to find, but these counties accounted for less than one-tenth of one percent of the state’s injured workers.

More details from the study, including medical access data by county, are in the “Report to the Industry, ‘California Workers’ Compensation Medical Care Reform & Access to Medical Care.'” Copies are available for $7.95 plus shipping, or Institute members and subscribers may download a copy from the Member/Subscriber section of the Institute Web site

Source: CWCI