CWCI Study Shows A 31 Percent Drop in California Workers’ Comp Hospital Stays Since 2010

Oakland – New California Workers’ Compensation Institute (CWCI) research shows the number of California workers’ compensation inpatient hospital stays fell nearly 31 percent from 2010 through 2018, fueled in large part by a steady decline in spinal fusions.

The study, authored by CWCI Senior Research Associate Stacy Jones, uses hospital discharge data from nearly 32.3 million inpatient stays compiled by the state Office of Statewide Health Planning and Development (OSHPD) to

measure and compare the volume and types of California inpatient hospitalizations paid under workers’ compensation to those paid by Medicare, Medi-Cal and private coverage.  Workers’ compensation is the smallest of the 4 medical delivery systems reviewed, accounting for just 0.4 percent of all inpatient stays in 2018, which is down from 0.6% in 2010, primarily due to a surge in Medi-Cal hospitalizations after 3.7 million adult Californians were added to the Medi-Cal rolls after Affordable Care Act plans became available in 2014.  At the same time, a number of factors spurred a decline in workers’ comp inpatient stays from 2010 to 2018, including:

• fluctuations in the number and types of claims;
• increased use of ambulatory surgery centers;
• the adoption of utilization review and independent medical review programs requiring that treatment meet evidence-based medicine standards;
• technological and procedural advances that allow more services to be provided in outpatient settings; and
• a 45.9 percent reduction in the number of spinal fusions since 2010, though fusions are still the top inpatient service rendered in workers’ comp, representing more than 1 in 6 injured worker hospitalizations last year.

In addition to tracking inpatient trends for California workers’ compensation, Medicare, Medi-Cal and private plans over the 9-year span of the study, other analyses and exhibits in the report provide detailed data showing:

• The breakdown of workers’ comp inpatient stays among the top 5 Major Diagnostic Categories (MDCs);
•  The proportion of surgical vs. “medical” (non-surgical) hospitalizations in each of the 4 payer groups;
• The top 5 workers’ comp surgical and medical inpatient discharges by diagnostic-related group (MS-DRG);
• The breakdown of the top 10 workers’ comp MS-DRGs across payer groups in 2018;
• The volume and prevalence of spinal fusion surgeries by payer group from 2010 through 2018;
• The top 10 hospitals based on the percentage of their inpatient discharges covered by workers’ comp, and the proportion of California workers’ comp medical and surgical hospitalizations rendered at those facilities.

CWCI has released its study as a Research Update report, “California Workers’ Compensation Inpatient Hospital Trends, 2010-2018.”  Institute members and subscribers can access the report in the Research section at www.cwci.org and others can purchase it for $17 from the Institute’s online Store.