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WCRI Day Two Conference – Morning – What I Learned Today

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What I Learned Today at the WCRI Conference – 2020

I decided to split out the Mental Health Session into its own article.

State of the States Selective Findings

Benchmark WCRI Conference 2020 at 78 magazine lane
Wikimedia Commons – Rodhullandemu

This session features selective findings and trends seen across WCRI’s core benchmark studies, including our 18-state CompScope™ Benchmarks reports, a multistate benchmarking program that measures the performance of a growing number of state workers’ compensation systems.  One set of findings will focus on readmission and reoperation rates as seen below.

Hospital Inpatient Metrics – Carol Telles, WCRI

Inpatient Hospital Payments account for 17% of Total Hospital Payments

Long Term Decrease in Hospital Inpatient Payments

Share of cases with 20,000 or less decreased, 20,000+ increased

Major surgery rate decreased 6 – 7 %  2017 to 2019

Iowa, Louisiana, and Massachusetts had increases in inpatient with surgery

Inpatient reimbursement rates – Indiana Minnesota and North Carolina had reductions from 2010 – 2017

Readmission and Reoperation Rates among Workers’ Compensation Patients

According to the Centers for Medicare and Medicaid Services, two of the main indicators of surgical quality are whether patients are readmitted or reoperated upon after a surgical procedure.

The parts of WCRI Conference 2020 Lumbar
Wikimedia Commons – Anatomist90

However, the research on these important indicators is limited for workers’ compensation patients who undergo lumbar spine surgery. In this session, we share preliminary research on this important topic.

Questions Addressed:

  • What are the readmission and reoperation rates in workers’ compensation for lumbar spine surgery?
  • How do these indicators vary across states as well as compare with other payor groups?
  • What are the implications of these indicators for payors, injured workers, policy makers, health care providers, and regulators?

Readmission and Reoperation Rates  – Dr. Randall Lea, WCRI

Two main markers of quality by non-WC payors

Readmission – unplanned hospitalization after a patient has been discharged

90-day timeframes in the study

Discectomy and Fusion were the two surgeries studied

Fixable/curable vs. non-fixable/manageable

Dr. Rebecca Yang – WCRI

Used the CompScope usual 18 states

72% of patients had a discectomy

28% had fusion

Studied 30,000 claims – 11% of patients with low back conditions had surgery

5.5% reoperation, 5.5% readmission, 4.9% both reoperation and readmission

California had 22% reoperation or readmission rate

7 – 8% of lumbar surgery cases had reoperation or readmission within 30 days and 90 days of surgery

7.2% had readmission or reoperation within 30 days.

56.4% decompression 43.6% fusion – reoperation rates

With no readmission or reoperation, $33,775 discectomy  $90,614 fusion

With readmission and reoperation $120,472  discectomy  $144,272 fusion

 

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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