Medata is proud to support the creditable organizations in our industry through membership, sponsorship and participation.  So far 2019 has kicked off to a great start!  Below are highlights from some of the recent shows we attended.   

California Division of Workers’ Compensation Conference

The State of California Division of Workers’ Compensation (CA DWC) recently held their 26th Annual Education Conference on February 11th and 12th, 2019 at the Los Angeles Airport Marriott…and Medata was there!  We were excited to see many of our clients and peers as well as getting the opportunity to learn more about some of the recent changes the CA DWC has implemented and some insight into what is coming in the near future.  The two day conference began on Monday, February 11th with introductions by CA DWC Administrative Director George Parisotto and Acting Chief Counsel Yvonne Hauscarriague who also gave an overview of recent DWC updates.  The following are highlights of some of the interesting and informative breakout sessions Medata attended:

  • DWC Update: This opening session included an overview of some DWC upcoming changes to regulations, processes, and forms; some of the recent anti-fraud measures put in place; an overview and update of MTUS (Medical Treatment Utilization Schedule) regulations and drug formulary; and updates and statistics regarding IME (Independent Medical Exams), IBR (Independent Bill Review), UR (Utilization Review), and QMEs (Qualified Medical Evaluators). This update pointed out that 357 providers have been suspended from DWC participation and there are currently 154 with lien stays. The presenters pointed out that an employer can defer paying bills for a provider whose liens have been stayed.  In addition, MTUS has resulted in a decrease in the number of Independent Medical Reviews (IME).
  • Formulary Focus: With the CA DWC drug formulary having eclipsed its first year of implementation, the CA DWC has found that the results thus far match those of other states, not only in cost effectiveness but also in cutting down prescription drugs as a percentage of total benefits and decreasing opioid prescriptions.  Some interesting facts that were presented:
    • Drug spending as a percentage of total benefits spending is down 20-50%.
    • In 2008, 33% of prescriptions were for opioids. That number has decreased 43% over the past 10 years now accounts for less than 20% of prescriptions.
    • California Workers’ Compensation is 161% higher than the national median for benefits costs. This is largely due to medical cost management and prescription oversight.

Perhaps the most interesting information presented was that when UR (Utilization Review) is utilized it’s resulting in patients reaching MMI (Maximum Medical Improvement) faster than without UR.

  • Discovery of Social Media Content in Workers’ Compensation Cases: With the heavy increase in use of electronic devices and social media, there are constant changes to laws and labor codes. This session covered issues related to discovery of social media content, employees’ right to privacy, what information is considered private and/or privileged, and the admissibility of social media content at trials.  The session also reviewed some federal laws impacting social media such as the National Labor Relations Act (NLRA), which protects the rights of workers to discuss wages and working conditions with other workers including posting on social media.  The presenters discussed potential ethical issues involved in using social media such as communicating with parties and witness on social media, “friending” judges, attorneys, witnesses, or opposing parties, and failure to preserve social media evidence for trial. Court decisions to allow social media evidence are based on relevance, if it can be authenticated, the weight/value of the evidence, and whether the evidence is hearsay or not.
  • Rating Spine Impairments: This session presented an overview of the spine and spinal segments, how to choose the proper rating method (DRE method vs. ROM method), and situations where both DRE and ROM methods are applicable. Presenters pointed out that ROM method tends to result in higher impairment ratings, and also that if a patient is over 50 they are likely suffering from a herniated disc while patients that are 50 or younger likely suffer from bulging discs.
  • Utilization Review: This session highlighted and discussed changes under SB 1160(2016) to the UR program and processes. The changes were intended to reduce delays in medical care, expedite appropriate care, increase communication between physicians and UR reviewers, and improve the overall quality of UR services. The presenters also covered the complete process of UR, beginning with the submission of a UR plan for approval, the application of rules in the UR process, and then finally UR investigations.  It was also pointed out that UR reviewers must be certified by URAC to do UR, drugs dispensed by a physician in the physician’s office are exempt from the formulary for a 7 day initial supply, and that routine investigations are done every few years while targeted investigations are performed only when a specific complaint is received.
  • Medical Treatment Utilization Schedule (MTUS) Including Formulary: In this session, we learned about the latest updates and changes to the MTUS including proposed regulation changes.
    • The American College of Occupational and Environmental Medicine (ACOEM) is currently updating the following guidelines:
      • Cervical and Thoracic Spine Disorders
      • Elbow Disorders
      • Ankle and Foot Disorders
      • PTSD and Acute Stress Disorder Guidelines
    • In addition, the following ACOEM guidelines are next in line to be updated:
      • Low Back Disorders
      • Hip and Groin Disorders
      • The next module in the Workplace Mental Health guidelines

Once the MTUS guidelines have been completely updated to follow ACOEM guidelines, then the CA DWC intends to keep it this way and institute any updates immediately.  The presenters also stated that there are possible enhancements coming to the MTUS drug list, including adding dosage form, strength, and a prescription CUI (Concept Unique Identifier). This data will be considered public domain and not proprietary.  MTUS guidelines are available online and access is free for providers.

Nevada Medical Fee Schedule Seminar

A seminar for the introduction to the Nevada Medical Fee Schedule 2019 was held on February 6, 2019 at the Nevada State Business Center. Katherine Godwin, RN, Manager of the Medical Unit covered each section within the Medical Fee Schedule.  With review of the information provided, there are no major revisions to the Medical Fee Schedule. The conversion factors were increased.  Effective with this update reimbursement for hospital services (e.g. trauma activation, emergency department and Nevada specific codes have been increased. Nevada state code NV00900 (Burn Care) has been deleted as it has been combined within state specific code NV00200 (ICU (cardiac, neuro, burn, other)) to calculate reimbursement.  Reimbursement values for ambulatory surgical center (ASC) and outpatient hospital Groups have also been increased for effective February 2019.  Questions asked during the seminar were related to down coding, out-of-state reimbursement and appeals.

WCRI

Workers’ Compensation Research Institute (WCRI) hosted an annual conference last week focusing on trends in workers’ compensation industry and opioid epidemic. A few interesting takeaways are as follows:

  • Sorry to start with bad news, but the number of drug overdose deaths in the US in 2017 was 70,237. Ten years ago the number was around 40,000.
  • The number of drug overdoses involving opioids the US in 2017 was 49,068. Ten years ago this number was around 20,000.
  • Higher rate of opioid prescriptions is seen in workers who were at age 40 – 60, residing in rural areas, employed in mining or construction, residing in counties with higher morphine milligram equivalent (MME) prescribing per capita, employed in smaller firms, had high job insecurity level.
  • Overall in WC industry, frequency of injuries has been declining and is one-third of values from early 90s. This behavior is consistent with data from European countries and is observed in all industrial sectors including high-risk industries and jobs.
  • Potential reasons for the decline in injury rates are the greater focus on safety, use of BI and data to improve safety and outcomes of injured workers, automation and robotics, under-reporting of injuries.
  • Cash benefits relative to wages per claim have been increasing. According to the Bureau of Labor Statistics, the labor force share of workers at age 55 and above is growing and it constitutes 22% in 2016 compared to 17% in 2006.  Aging of workforce is associated with an increase in severity of injuries and, therefore, higher payments.

The other topics that were discussed included increased number of surgeries provided in outpatient settings, especially ASCs; correlation between higher group health deductibles and filing for WC; increased percent of claims with lump-sum settlements; significant growth of telemedicine.