At the 2018 WCRI Annual Research & Issues Conference a panel presented findings from several different WCRI studies. Please note, some of these findings are preliminary, and therefore, subject to change. Then panel included:
- Ramona Tanabe, WCRI
- Evelina Radeva, WCRI
- Rebecca Yang, WCRI
- Carol Telles, WCRI
The WCRI study measured the impact of the 2013 reforms. They study found the average PPD per claim decreased by 24% after the reforms. The law change included limits on PPD benefits and changed the method of calculating these benefits. Prior to these legislative changes PPD costs in Tennessee were higher than the average states in WCRI studies.
There was also a significant decrease in attorney fees, which were tied to changes in the litigation process and included creating dedicated workers’ compensation appellant judges. Prior to that, workers’ compensation appeals litigated in civil courts which led to higher than average litigation costs. Injured worker attorney involvement also decreased as the reforms also included ombudsman to help in resolving disputes without litigation.
Physical Medicine Services
The WCRI study showed that physical medicine treatment rendered on claims has shifted from hospital to non hospital settings in many study states. This is likely related to differences in fee schedules for services performed in a hospital vs non hospital. Fee schedules for treatment in a hospital setting are often higher than the same treatment in non hospital settings. As payers become aware of these differences in pricing, they make a conscious effort to refer patients to the non hospital settings.
Time From Injury to Medical Treatment
The WCRI study examined medical treatment delays on claims. There are many reasons for delays in medical care including gradually worsening symptoms and administrative delays. The study did not examine the reason for the delay in treatment. According to the study, the delays were typically on soft tissue injuries. State treatment guidelines could have a significant impact on treatment lag times for example California does not allow for MRIs during the first few weeks post injury. The study did not correlate the differences in treatment lag time to claim outcomes such as return to work, etc.