February 7, 2020

WCIRB Publishes Physical Medicine Report

The Workers’ Compensation Insurance Rating Bureau (WCIRB) of California released Physical Medicine Treatments and Their Impact on Opioid Use and Lost Time in California Workers’ Compensation, which analyzes the impact physical medicine has on opioid utilization.

Following a 2019 study on high-risk opioid use that found physical therapy (PT), acupuncture, and chiropractic care were consistently and significantly utilized more on claims involving lower doses of opioids, this report was drafted to find further patterns and trends in physical medicine cost and utilization.

This new report analyzed over 1.5 million claims that had a work-related injury and at least one medical service paid in the California workers’ comp system from 2013-2018. According to the study, concurrent increases in physical medicine costs along with sharp declines in utilization and payments for opioids suggest that physical medicine may have been used to substitute for opioids used to control pain.

Over 170,000 claims had a soft tissue injury to the shoulder, back, neck or knee from 2013-2017, and more than 50% involved at least one physical medicine service.

According to the report, the average medical payment for physical medicine continued to rise from 2013 through 2018, contributing to a growing proportion of the total medical paid per claim (8% to 11%) as well as the medical paid for physician services per claim (16% to 25%). Overall, the share of total medical payments for physical medicine increased 75% from 2013-2018.

The report found that soft tissue injury claims involving PT during the first 30 days of the initial medical visit were less likely to initiate opioid use within one year of the injury, compared to similar claims without early PT. Between 2015 and 2017, utilization of claims involving early utilization of PT were found to have significantly lower odds of opioid use by about 14% on average.

And while chiropractic care was less frequently used on soft tissue injury claims, its early use was found to be associated with a significantly lower probability of opioid use. Early chiropractic care within the first 30 days of injury was associated with 16% lower odds of opioid use.

Among soft tissue injury claims that had at least one opioid prescription within one year of the injury, those with early PT had, on average, significantly lower doses of opioids prescribed, by 23%, than similar claims without early PT.

The study states that legislation which removed requirements for prospective utilization review (UR) for certain medical services provided within 30 days of injury, including physical medicine, may have contributed to increases in physical medicine utilization and decreases in opioid utilization.

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