Drop in medical reviews in California continued in first half
The California Workers’ Compensation Institute reported that after hitting a new low in 2021 the volume of independent medical review decision letters continued to decline through the first half of this year.
S.B. 863 in 2013 created the administrative IMR process to resolve disputes over treatment requests without involving judges. Lawmakers anticipated that IMR volume would decline as providers became familiar with treatment guidelines, but it was not until 2019 that volume dropped sharply, falling by 11.3% to a 5-year low of 163,899, with the annual letter counts subsequently declining another 16.6% to 136,738 in 2020 (the initial year of the pandemic), followed by a 2.4% decline to 133,494 letters in 2021, CWCI said in a bulletin released Wednesday.
The decline continued in the first half of this year as the letter count fell 7.6% from the year-earlier period to a record low of 62,859.
CWCI said IMR decisions can include determinations on multiple disputed treatments, but the number of service decisions is also trending down.
In 2019, IMR physicians rendered decisions on 261,708 service requests. The count fell 17.5% to 215,788 disputed treatments in 2020 and fell again to 209,782 in 2021. In the first half of this year, there were 97,649 decisions on primary medical service requests.
Disputes over pharmaceuticals dropped from 47.3% of all IMRs in 2017 to 34.9% in 2021 and 33.9% of IMR decisions in the first half of this year.
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