Key Finding from WCRI Studies
At the 2020 WCRI Annual Issues and Research Conference, a session discussed key findings from various WCRI studies. The presenters were:
- Carol Telles – WCRI
- Dr Randall Lea – WCRI
- Dr Rebecca Yang – WCRI
Trends in Hospital Inpatient Metrics
- Hospital inpatient payments accounted for 17% of total medical payments in the typical study state.
- Range was 12% to 23% in study states.
- The long-term trend is a decrease in the percentage of claims with hospital inpatient care. A big factor in this trend is increased use of outpatient surgical centers.
- The study showed an increase in costs per inpatient admission in most study states. The median increase from 2012-2017 was 7.2%. Thus, while there are less inpatient admissions, the remaining ones are for more serious and costly injuries.
- There was an overall decrease in the surgery rate seen in study states. This is likely due more treatment guidelines around surgeries being implemented. There has been an increased focus in the medical community on the appropriateness of back surgery and non-surgical options are increasingly popular.
- Very little research in this area.
- Study sought to discover how workers’ compensation hospital readmission rates and reoperation rates compared to group health.
- CMS measures readmission rates within 30 days of the initial admission. Most researchers feel the appropriate time frame to consider is 90 days.
- The study focused on low back conditions treated with surgery in 18 Compscope study states using data from 2016-2018.
- Note that this study is preliminary so the results are subject to change.
- The study showed 16% of surgical spine cases had reoperation, readmission, or both. 5.5% reoperation, 5.5% readmission, 4.9% both.
- Lumbar fusion cases had higher rates of readmission compared to other lumbar surgeries.
- Rate of reoperation and readmission varied significantly across study states. California had a rate of 22%, while North Carolina and Minnesota had 11% rates.
- There was no correlation between surgical rates and reoperation rates. California had the lowest surgical rate but the highest reoperation/readmission rate.
- Most of the readmission/reoperation happened within 30 days of the initial surgery. There were few additional occurrences when you looked at 90 days vs 30 days.
- Workers age 55-65 had a higher percentage of readmission/reoperation compared to workers age 25-39 and 40-54.