Texas Workers Compensation System Trends Presentation for the Texas Self Insurance Association

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Texas Workers' Compensation System Trends Presentation for the Texas Self Insurance Association Amy Lee Texas Department of Insurance Workers' Compensation Research and Evaluation Group

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What This Presentation Will Cover Workers' pay organize interest Medical expenses and use of care Factors influencing restorative costs Access to care and fulfillment with care Return-to-work results Employer cooperation rates in the Texas laborers' remuneration framework

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Network Participation Has Increased; However, a Relatively Small Percentage of Claims Are In Network

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Results from Data Call of Top 13 Insurance Carrier Groups As of July 1, 2008, 12 out of 13 transporter bunches have contracted with or set up an affirmed WC arrange (an expansion from 9 in Sept 2006) All bearer bunches with a system have as of now started offering it to policyholders and 10 out 12 transporters are putting forth a premium credit Premium credits offered for system support – up to 15% among transporters Most taking an interest policyholders were little and fair sized businesses Carriers assess that more than 104,000 specialists will be dealt with by systems before the end of CY 2009

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Total Number of Policyholders That Participated in Networks, Top 13 Insurance Carrier Groups Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group. 2008.

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Results from Certified Networks' Data Call Currently 33 systems are affirmed by TDI covering more than 234 Texas provinces As of February 1, 2009, around 76,000 harmed specialists were dealt with by 18 guaranteed systems, contrasted with 40,000 laborers treated by 8 arranges a year prior Additionally, 12,000 harmed laborers were dealt with by political subdivision organize programs worked under Chapter 504, Labor Code Roughly 16% of all new wounds are being dealt with by systems and this rate hasn't changed fundamentally in over a year Most of these laborers, notwithstanding, are as yet being dealt with by one system; however a modest bunch of different systems have started expanding their investment rates There are still a few systems confirmed by TDI that don't have any protection transporter contracts set up

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Medical Costs and Utilization of Care Have Stabilized Over Time, yet Effect of Networks is Mixed

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Total Medical Payments (Professional and Hospital), One-Year Post Injury, Unadjusted, Injury Years 1998-2006 Note: Injury Year 2004 was barred from this investigation because of missing information. Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008.

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Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Unadjusted, Injury Years 1998-2006 Note: Injury Year 2004 was barred from this investigation because of missing information. Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008.

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Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Adjusted, Injury Years 1998-2006 Note: Injury Year 2004 was avoided from this examination because of missing information. Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008.

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AVERAGE MEDICAL COST PER CLAIM, 6 MONTHS POST INJURY Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Medical cost contrasts between non-organize and Corvel Corcare, Liberty HCN, and different systems are measurably huge. The figures displayed above are balanced for harm sort and kind of claim contrasts that may exist between the gatherings.

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Factors Affecting Medical Costs in the Texas Workers' Compensation System

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Number of Workers' Compensation Claims Reported to the Division of Workers' Compensation, Injury Years 1998-2007 Note: These numbers incorporate the cases that are required to be accounted for to DWC, including fatalities, word related infections, and wounds with no less than one day of lost time. Medicinal just claims are not required to be accounted for to DWC. Source: Texas Department of Insurance, Division of Workers' Compensation, 2008.

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Percentage of Injured Workers Receiving Professional, Hospital and Pharmacy Services, 6 Months Post Injury Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Take note of: The figures displayed above are balanced for harm sort and kind of claim contrasts that may exist between the gatherings. Reference bullets (*) shows that the contrasts between the system and non-system are factually huge.

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Average Number of Evaluation and Management Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was rejected from the investigation because of missing information. The figures above are balanced for damage sort and claim contrasts.

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Average Number of Other Physical Medicine Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was barred from the examination because of missing information. The figures above are balanced for harm sort and claim contrasts.

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Average Number of Spinal Surgery Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was rejected from the investigation because of missing information. The figures above are balanced for harm sort and claim contrasts.

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Percentage of Reportable Claims That Are Initially Denied/Disputed for the Top 25 Workers' Compensation Carriers, Injury Years 1998-2006 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. 1 The 2006 figures ought to be translated with alert since the information are inadequate. 2 House Bill (HB) 2600, a specialists' remuneration change charge went for lessening medicinal expenses was passed in 2001.

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Percentage of Medical Services Denied for the Top 25 Workers' Compensation Carriers for Service Years 1998-2007 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note 1: Denial rates for 2007 ought to be deciphered with alert since these number are provisional. Note 2: House Bill (HB) 2600, a specialists' pay change charge went for decreasing medicinal expenses, was passed in 2001. Note 3: In August 2003, the latest expert medicinal charge rule, which joined Medicare's installment arrangements, became effective.

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Some Improvements in Workers' Perceptions Regarding Access to Care Over Time, however Generally Workers in Networks Have Poorer Perceptions

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Methods Injured Workers Reported Using to Select Their Treating Doctor Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008. Note: "Chose in other way" incorporates suggestions from family or companions or different collaborators, among others.

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Type of First Non-Emergency Treating Doctor Selected by Injured Workers Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

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Percentage of Injured Workers Who Reported Having Problems Getting Medical Care for Their Injury Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

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GETTING NEEDED CARE percent of harmed laborers who reported no issue getting: an individual specialist they like · to see an expert · fundamental tests or treatment · convenient endorsements for care Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Differences between non-organize and Corvel Corcare, Liberty HCN, and different systems are measurably noteworthy. The figures displayed above are balanced for harm sort, kind of claim, race/ethnicity, sexual orientation, age, training, period of damage at the season of the overview, protection scope, and self-appraised wellbeing contrasts that may exist between the gatherings

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OVERALL SATISFACTION WITH MEDICAL CARE percent of harmed laborers who showed that they were " to a great degree fulfilled" with the nature of the restorative look after their business related damage Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note: Differences between non-system and Texas Star, Corvel Corcare, Liberty HCN, and different systems are factually huge. The figures exhibited above are balanced for harm sort, kind of claim, race/ethnicity, sexual orientation, age, instruction, time of damage at the season of the review, protection scope, and self-appraised wellbeing contrasts that may exist between the gatherings

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Return-to-Work Outcomes Continue To Improve, however Network Results Are Mixed

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Initial Return-to-Work Rate Percentage of Injured Workers Back At Work interestingly 6 Months to 3 Years Post-Injury Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2008. Note 1: The study populace incorporates 392,331 specialists harmed in 2001-2006 who likewise got Temporary Income Benefits (TIBs). Note 2: Although the increments of introductory RTW rates were little, they were measurably noteworthy at the 0.01 importance level.

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Mean and Median Days Off Work for Injured Workers Who RTW At Some Point Post Injury Years 2001-2005 Source: Texas Department of Insurance, Workers' Compensation Research and Evaluation Group, 2007. Note 1: "

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