Today’s issue of WorkCompRecap features the release of a new report from CWCI that found that Independent Medical Review (IMR) volume dipped for the first time ever in 2017, but the outcomes were unchanged, as IMR physicians again upheld 91.2% of modified or denied medical service requests reviewed.
The Institute’s review of 2017 IMR results found that the 91.2% uphold rate was exactly the same as in 2014 and 2016, and service request mix showed only minor changes from 2016. Prescription drug requests (29.1% of which were for opioids) retained the largest share of IMRs (46.0% vs. 47.9% in 2016), with UR determinations on pharmaceutical requests upheld 92.0% of the time. Compound drug requests fell from 6.5% of the drug IMRs in 2016 to 4.2% in 2017, the biggest decline of any prescription drug category, which CWCI noted may be linked to the fact that IMR physicians have consistently deemed them not medically necessary in 99% of cases.
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