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
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.
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.
- 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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