San Francisco, CA – The California Division of Workers’ Compensation (DWC) recently released its 2013 study on access to medical care for injured workers, which finds that most workers have nearby access to providers and are satisfied with the medical care they receive.
The Labor Code requires that DWC complete annual studies to ensure workers have access to medical care. New to this year’s report are data from medical claims submitted to the Workers’ Compensation Information System (WCIS). The other source for the report, completed by the Berkeley Research Group, was a survey of workers injured in 2011 and 2012.
“Access to quality care and the ability to return to work is extremely important to the Department. Our use of medical claims data yields essential quantitative data that can be used in the future to compare pre-reform and post-reform trends for injured worker treatment,” said Christine Baker, Director of the Department of Industrial Relations (DIR). The Division of Workers’ Compensation is a division of DIR.
This study marks DWC’s first effort to review medical claims data in order to gauge injured workers’ access issues. Previous studies conducted in 2006 and 2008 focused solely on survey data. All three studies included a survey of injured workers to measure their satisfaction with the care they received. Although survey methods differed, the findings for each survey were similar: 85 percent of the injured workers noted they were satisfied or very satisfied with their care.
WCIS uses electronic data to collect comprehensive information from claims administrators. The WCIS medical claims data indicated that the number of injured
workers who obtain care from specialists rather than general practitioners is increasing, while the overall number of providers treating injured workers has not changed.
“We’re pleased to see that the majority of injured workers have access to needed care without barriers,” said DWC acting Administrative Director Destie Overpeck. “At the same time, this study does show that improvements are needed to increase rates of recovery and job modifications.”
Among the 500 randomly selected workers injured in the last quarter of 2011 or the first quarter of 2012, the following was found:
- 84 percent expressed satisfaction with their main health care provider and 85 percent of those whose saw specialists were satisfied with the care they received.
- 7 percent of workers reported that they were denied care.
- Reasons cited by those workers who expressed dissatisfaction included:
- Denial of care by the workers’ compensation program.
- Not being treated with courtesy or respect by their main provider or a specialist.
- Lack of improvement in their condition.
- Difficulties getting appointments.
- 85 percent of injured workers saw a health care provider, most frequently a general practitioner, within three days of their injury
- 32 percent saw a specialist.
- 50 percent of injured workers saw a physical or occupational therapist during the period of their care.
- The distance traveled to the first provider visit was most frequently less than six miles (55 percent) and took less than 16 minutes (59 percent).
- Very few injured workers (3 percent) traveled over 30 miles (3 percent) or over an hour (6 percent).
- Half of those who traveled more than 30 miles did so because there were no providers closer to their homes or workplaces.
- Injured workers reported receiving care through a Medical Provider Network (“MPN”) 85 percent of the time.
- 35 percent spent between eight days to one month and another 35 percent spent over one month under the care of a physician or health care provider (HCP).
- Most injured workers (62 percent) reported that their main provider understood the physical and mental demands of the worker’s job very well, discussed the need for work restrictions or changes in the job (77 percent) and discussed how they should avoid re-injury (64 percent).
- 11 percent indicated that they were represented by attorneys.
The study has been posted online here: CA Division of Workers’ Compensation 2013 Medical Access Study (PDF)
Source: CA DWC