If the volume of independent medical review decisions issued in the first half of 2022 holds for the rest of the year, disputed medical treatment decisions in California’s workers’ compensation system would fall for a fourth consecutive year.
Ray Meister, executive medical director of the Division of Workers’ Compensation, said during a Health and Safety and Workers’ Compensation Commission meeting Thursday that 62,859 IMR decision letters were issued from January to June. If that pace holds through the last six months of 2022, that would result in a little more than 125,700 decisions for the year.
The data that Mr. Meister presented shows a steady increase in the number of IMR decision letters from 143,840 in 2014, the first year all medical treatment disputes were eligible for the administrative resolution process created by new state law, to a peak of 184,733 in 2018.
IMR volume fell to 163,755 in 2019 to 136,740 in 2020 and to 133,430 in 2021.
Mr. Meister credited a feedback loop for helping to reduce the number of IMR disputes, as well as the addition of a prescription drug formulary to the medical treatment schedule.
“Vendors, through (the utilization review) and the IMR process, may learn about what the recommendations are and what will be approved as consistent with the guidelines,” he said. “We think another factor is likely the formulary and the MTUS drug list, which came into place in 2018. There is always a large percentage of IMR decisions that involve medications, and those numbers have gone down.”
Mr. Meister said the IMR continues to uphold about 92% of disputed use review decisions. Mr. Meister also shared updated numbers showing a short-lived bump in the number of qualified medical evaluators. The number of QMEs increased to 2,545 in 2021 from 2,480 in 2020 before falling to 2,440 in 2022.
The division has a sufficient number of QMEs for some specialties such as orthopedics, but for others it does not have enough providers to create a panel, he said.
WorkCompCentral is a sister magazine to Business Insurance. More stories here.