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Independent medical reviews dip in California: Study

Posted On: Mar. 15, 2018 12:02 PM CST

Independent medical reviews dip in California: Study

The volume of independent medical reviews in California declined in 2017 for the first time since the state adopted its practice of reviewing medical claims for injured workers, according to a report released Thursday by the Oakland, California-based California Workers Compensation Institute.

The Division of Workers Compensation data show 3,808 fewer cases in 2017 than in 2016, which translates to a 2.2% decline, the institute announced in its study.

State lawmakers adopted review standards in 2012, anticipating that once doctors, attorneys and others came to know which services could be approved as meeting evidence-based medicine standards the process would reduce treatment disputes, but 2017 marks the first time in the five years since its inception that IMR volume has declined, the institute stated in the report.

Further study of 648,450 IMR decision letters issued from 2014 to 2017 found that outcomes were unchanged as reviewing physicians again upheld 91.2% of modified or denied medical service requests that they reviewed, the institute revealed. The figure remained unchanged since 2014.

The mix of service requests reviewed by IMR physicians in 2017 showed only minor changes from 2016. Prescription drug requests — 29.1% of which were for opioids — again accounted for the largest share of the review requests at 46.0%, down from 47.9% in 2016, the study showed.