Today’s issue of WorkCompRecap features the release of a new CWCI analysis that found in 2016, IMR physicians in California’s system once again upheld about 90% of utilization review (UR) physician’s modifications or denials of treatment, yet IMR volume continued to grow, climbing 6.5% last year.
CWCI noted that legislators had expected treatment disputes to decrease once system participants came to understand which services could be approved because they meet evidence-based medicine standards. Three years in, however, IMR volume is at a record high, as the DWC reported 10,477 more cases in 2016 than in 2015. Service mix showed little change, with prescription drug requests (28.5% for opioids) making up nearly half of all IMRs, with UR mods/denials upheld 92.5% of the time. Finally, a small portion of doctors (10%) remain responsible for 85% of requests, with the top 1% (just 125 providers) accounting for 44%.
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