|Newsline No. 18-07|
|February 23, 2007|
Division of Workers Compensation releases study on access
to medical care in Californias workers compensation system
Study shows most injured workers have access to quality care
The California Division of Workers Compensation (DWC) today released a study on access to medical care for injured workers. The study reveals that the vast majority of injured workers have access to quality care. The study also shows the majority of injured workers are satisfied with their care, and levels of satisfaction appear unchanged from a similar study done in 1998.
This study shows that, following the introduction of evidence-based medicine and treatment guidelines, most injured workers feel they are getting the care they need, said Division of Workers Compensation Executive Medical Director Dr. Anne Searcy. It also points out where we need to improve, and gives us a baseline from which to measure the impact of changes we make going forward.
Among the nearly 1,000 injured workers surveyed between May and October of 2006, the vast majority reported they were able to see a doctor right away, did not have to travel far to see their doctor and were able to get specialty care, physical therapy and prescriptions they needed.
The report also showed that the health and return to work outcomes of injured workers need further improvement, especially among those with high levels of utilization.
The 2003 workers comp reforms added section 5307.2 to the Labor Code, which requires DWC to contract with an independent firm to perform an annual study of access to medical treatment for injured workers. This first study was conducted by the University of California at Los Angeles (UCLA), Center for Health Policy Research.
While 82 percent of injured workers reported having access to quality medical care for their injury, some doctors surveyed for the study perceived a decline in access to quality care since the reforms.
The fact that physicians report perceived declines in quality as a result of the 2003 and 2004 reforms isnt surprising, said Gerald F. Kominski, associate director of the UCLA Center for Health Policy Research and lead author of the study. Some doctors are understandably dissatisfied because these reforms placed limits for the first time on the volume and type of services that can be used to treat injured workers. Whats important is that these negative perceptions of doctors regarding access and quality do not reflect the actual experience of most injured workers.
The majority of physicians that perceived a decline in injured workers access to care -- chiropractors, acupuncturists and orthopedic surgeons -- also reported a decline in their workers compensation patient volume since 2004.
Some decline in overall patient volume is expected because the actual number of claims in the system has decreased and caps were placed on physical medicine, Dr. Searcy said. But pending medical treatment regulations, which include guidelines for acupuncture, will address the decline in access to acupuncturists.
Among the nearly 1,100 medical providers surveyed between April and October of 2006, the majority intend to continue providing treatment to workers compensation patients. However, about one in five intend to decrease their volume of workers compensation patients in the future, and about 14 percent plan to quit entirely. In both cases, the physicians most frequently cited payment, paperwork and utilization review issues as their motivation.
The division recently proposed regulations that will increase reimbursement to doctors for most office visits by an average of 23 percent, said Searcy. This, along with vigorous enforcement of our utilization review rules, should help alleviate the doctors main concerns. Were also working to decrease paperwork through electronic billing and a better reporting form.
More of the studys key findings can be found below. The entire study can be found on the DWCs Web site at http://www.dir.ca.gov/dwc and on the UCLA Center for Health Policy Research Web site at www.healthpolicy.ucla.edu.
Access to medical care in Californias workers
Among the nearly 1,000 injured workers surveyed between May and October, 2006:
Although the overall percentage of injured workers experiencing problems accessing care is low, the number of individuals potentially affected is large, given the approximately 780,000 workplace illnesses and injuries reported in 2005, the year the injured workers who participated in this study filed their claims.
The health and return to work outcomes of injured workers need further improvement, especially among those with high levels of utilization.
The doctors providing care are properly counseling injured workers on returning to work safely: Both injured workers and doctors report that treating physicians understand job demands and are discussing work restrictions, as well as ways to avoid re-injury, with injured workers.
Among the nearly 1,100 medical providers surveyed between April and October, 2006, the majority intend to continue providing treatment to workers compensation patients. About one in five medical providers intend to decrease their volume of workers compensation patients in the future, and about 14 percent plan to quit entirely. The most common reasons cited for planned decreases are:
Providers that are no longer treating injured workers cited the same reasons for leaving the system.
Among providers currently accepting workers compensation patients, chiropractors (90 percent), acupuncturists (87 percent), and orthopedic surgeons (55 percent) were the most likely to have reported declines in their workers compensation patient volume since 2004.
These provider types, in addition to clinical psychologists, were also the most likely to perceive problems in access to quality care for injured workers and declines in access and quality since 2004.