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Medical Access Study. Report of Research in Progress at 13 th Annual DWC Educational Conference Los Angeles, March 1-2, 2006 Oakland, March 6-7, 2006 Lisa Dasinger, PhD Project Director Medical Unit, Division of Workers’ Compensation. Outline. LC 5307.2 Study Context

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Medical access study

Medical Access Study

Report of Research in Progress

at 13th Annual DWC Educational Conference

Los Angeles, March 1-2, 2006

Oakland, March 6-7, 2006

Lisa Dasinger, PhD

Project Director

Medical Unit, Division of Workers’ Compensation


Outline

Outline

  • LC 5307.2

  • Study Context

  • Study Questions to be Addressed

  • Study Teams

  • Study Design

  • Project Timeline

DWC Medical Access Study


Lc 5307 2

LC 5307.2

  • AD shall contract …(an independent research consultant) … to perform an annual study of access to medical treatment for injured workers.

    The study shall:

  • Analyze whether there is adequate access to quality health care and products

  • Make recommendations to ensure continued access

DWC Medical Access Study


Lc 5307 21

LC 5307.2

  • If the AD determines … there is insufficient access … AD may make appropriate adjustments to medical and facilities’ fees

  • If substantial access problems exist, AD may … adopt fees in excess of 120 percent of the applicable Medicare payment system fee for the applicable services or products

DWC Medical Access Study


Study context sb228 and sb899 introduced major changes into the wc system

Study Context: SB228 and SB899 introduced major changes into the WC system

As of January 1, 2004

  • repeal of the treating physician’s presumption of correctness

  • adoption of peer-reviewed, nationally recognized evidence-based medical treatment guidelines (ACOEM guidelines)

  • establishment of a mandatory utilization review process by employers

  • 24 visit limit on chiropractic and physical therapy for the life of a claim

  • 5% reduction in fees for most physician services

DWC Medical Access Study


Study context sb228 and sb899 introduced major changes into the wc system1

Study Context: SB228 and SB899 introduced major changes into the WC system

As of January 1, 2005

  • Employers may establish Medical Provider Networks (MPNs)

  • And other changes

DWC Medical Access Study


Study context sb228 and sb899 introduced major changes into the wc system2

Study Context: SB228 and SB899 introduced major changes into the WC system

These changes potentially affect access to

medical care at many levels:

  • whether and how much physicians are willing and able to participate in the WC system and treat injured workers

  • the nature, quantity, quality, and timeliness of medical care an injured worker receives

  • who controls access to medical care

DWC Medical Access Study


Study questions to be addressed

Study questions to be addressed

  • What is the current nature of access to health care and health care products?

  • Is there access to quality health care and health care products?

  • If access problems exist, are they substantial?

DWC Medical Access Study


Study teams

Study Teams

  • Division of Workers’ Compensation

    Dr. Lisa Dasinger, Project Director

    Dr. Anne Searcy, Associate Medical Director

    Suzanne Marria, Legal Counsel

    Kathy Dervin, Manager

    Dr. Glenn Shor, Research Program Specialist II

  • UCLA Center for Health Policy Research

    Dr. Dylan Roby, Project Director

    Dr. Gerald Kominski, PI

    Dr. Nady Pourat, Co-PI

    Dr. E. Richard Brown, Co-PI

  • SFSU Public Research Institute

    Dr. John Rogers, Project Director

    Dr. James Wiley, PI

DWC Medical Access Study


Study teams ucla center for health policy research

Study Teams: UCLA Center for Health Policy Research

  • One of the nation's leading health policy research centers

  • Premier source of health policy information in California

  • Studies on:

    -- access to health care among vulnerable populations

    -- workers’ compensation managed care

    -- physicians and physician fee schedules

  • Conducts California Health Interview Survey (CHIS) - largest continuing state health survey in the country and important source of information on health and access to health care services

DWC Medical Access Study


Study teams sfsu public research institute

Study Teams: SFSU Public Research Institute

  • Provides high quality research, data collection, and analysis to government agencies, non-profits, and academic researchers in California

  • Conducted hundreds of surveys in its 21 year history

  • State-of-the-art survey research center

  • Multilingual capabilities

  • PRI’s Director conducted 1998 DWC study on injured workers

DWC Medical Access Study


Study design

Study Design

Four surveys

  • Physician Survey – Current and Past Workers’ Compensation Providers

  • Physician Survey – California Physicians

  • Injured Worker Survey

  • Claims Administrator Survey

DWC Medical Access Study


Access questions examples

Access Questions: Examples

  • Time to first medical visit

  • Distance traveled to first medical visit

  • Time traveled to first medical visit

  • Problems getting in to see a specialist

  • Problems getting in to see a physical therapist

  • Problems getting prescription medication

DWC Medical Access Study


Quality questions examples

Quality questions: Examples

  • How well doctor most involved in care understood worker's job

  • Whether doctor most involved in care treated worker with courtesy and respect

  • Satisfaction with doctor most involved in care

  • Overall satisfaction with health care

  • Able to get access to quality health care

  • Recovery from injury

DWC Medical Access Study


Project timeline

Project Timeline

  • July 2005 to February 2006

    -- Literature and survey instrument review

    -- Survey development

    -- Sample design and selection

    -- IRB applications (UCLA, SFSU, State)

  • February 2006 (planned)

    -- Interviewer training

    -- Pilot testing

  • March 2006 (planned)

    -- Begin data collection

DWC Medical Access Study


Medical access study

Questions?

DWC Medical Access Study


Appendix lc 5307 2

Appendix: LC 5307.2

“The administrative director shall contract with an

independent consulting firm, to the extent

permitted by state law, to perform an annual

study of access to medical treatment for

injured workers. The study shall analyze whether

there is adequate access to quality health care

and products for injured workers and make

recommendations to ensure continued access.

DWC Medical Access Study


Appendix lc 5307 21

Appendix: LC 5307.2

If the administrative director determines, based on this

study, that there is insufficient access to quality health

care or products for injured workers, the administrative

director may make appropriate adjustments to medical

and facilities' fees. When there has been a

determination that substantial access problems exist,

the administrative director may, in accordance with the

notification and hearing requirements of Section

5307.1, adopt fees in excess of 120 percent of the

applicable Medicare payment system fee for the

applicable services or products.”

DWC Medical Access Study


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