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Those who reviewed drugs and other treatments for injured workers in California scaled back the wait times in 2016 from an average of 24 days to an average of 14 days, according to a report released Thursday by the California Department of Industrial Relations.
The Independent Medical Review Organization processed nearly 250,000 applications, a slight decrease from 2015. Overall, requests for pharmaceuticals in 2016 comprised 43.5% of the issues in dispute, with opioids the most common drug class under review at 30% of drug-review requests, the report states.
Rehabilitation services — such as physical therapy, chiropractic and acupuncture — were the second-most-requested category at 13.6% of overall review requests, followed by diagnostic testing at 13.3%. The treatment category most often overturned was evaluation and management with a 20% overturn rate; this includes specialist consultations and dental services, followed by psychiatric services, which had an 18% overturn rate, the report states.
The Independent Medical Review Organization overturned 8.4% of the utilization review decisions that denied treatment requests made by physicians, according to the report.
After passing reforms aimed at reducing workers compensation costs in 2012, California legislators and workers comp professionals are implementing more changes to the system, but this time they are targeting provider fraud.