California CWCI Publishes Quarterly Report on IMR Statistics – The Other Numbers
The California CWCI (California Workers Compensation Institute) recently published a spotlight report on the state’s Independent Medical Review (IMR) process. The IMR process was initiated due to Senate Bill 863.
If a UR (utilization review) physician provides an opinion which denies the medical treatment, the injured employee has the right to dispute that finding.
If the injured employee decides to dispute the decision of the UR physician, the IMR process provides an avenue to have an independent physician review the denial of services. The IMR physician can overturn or uphold the decision.
The main statistics that created a buzz in the Workers Comp blogosphere are:
- 90% of all denials were upheld
- 160,000 review letters
- 1/2 of the reviews were for medications (40% of the medication reviews were for opioids)
As they say in Monty Python(c), now for something completely different:
- Over 20% of psychological services denials were overturned by the IMR physician
- Almost 30% of the “evaluation and management” services denials were overturned by the IMR physician
Both of these two service categories did not make up a large amount of the IMR reviews. However, the percentage of overturned denials was remarkable.
One area from the medication IMR statistics by CWCI was antidepressants. The IMR physicians had overturned almost 30% of the antidepressant denials. Even though antidepressants accounted for only 4% of the reviews, this was a striking number.
The most interesting statistic, in my opinion that came from the CWCI study was that the top 10% of medical providers that were mentioned in the IMR letters accounted for 75% of the reviews.
Will California’s Department of Workers Comp look more into that statistic? We shall see.
The study can be found here.
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