Study: Use of Physician Networks in California Workers’ Comp at Record High

November 29, 2011

A California Workers’ Compensation Institute study released on Tuesday shows the use of network physicians to provide medical care to injured workers in California has continued to grow over the past five years and now stands at a record high.

The use of network physicians to provide medical care to injured workers in California rose sharply in 2005, immediately after Medical Provider Networks (MPNs) first became available in California workers’ compensation, expanding employer medical control from 30 days to the life of the claim, according to the study.

The study uses first-year medical visit data from more than 1 million California workers’ compensation claims with injury dates from 2004 through the 3rd quarter of 2010. The report’s authors measured the percentage of outpatient services delivered by network providers before and after MPNs began operations in January 2005.

The results show the network utilization rate for first-year physician-based outpatient services rose from 51 percent for accident year (AY) 2004 claims, the final year before MPNs became available, to more than 64 percent for AY 2005 claims.

Network utilization has continued to grow since then, with the latest data showing that network providers accounted for more than 75 percent of all first-year, physician-based outpatient services rendered on AY 2009 claims.

The study measured changes in the proportion of services rendered by network providers within and beyond 30 days of injury to assess how much of the increase in first-year network utilization was tied to the expansion of employer medical control.

Before MPN’s in 2004, networks accounted for more than seven out of 10 physician-based inpatient medical services in the first 30 days post injury. After MPNs took effect in 2005 that rate rose slightly to about 74 percent.

The network utilization rate for services beyond 30 days post-injury rose from 39 percent for 2004 claims to 57 percent for 2005 claims, the study shows.

However, since that initial surge the study found comparable growth in the network utilization rate for services within and beyond the first 30 days, a sign that use of MPNs has now become widespread, and that injured workers are now typically channeled to network providers at the outset of their claims, the study shows.

Topics California Workers' Compensation

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