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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. What This Presentation Will Cover. Workers’ compensation network participation

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texas workers compensation system trends presentation for the texas self insurance association

Texas Workers’ Compensation System TrendsPresentation for the Texas Self Insurance Association

Amy Lee

Texas Department of Insurance

Workers’ Compensation

Research and Evaluation Group

what this presentation will cover
What This Presentation Will Cover
  • Workers’ compensation network participation
  • Medical costs and utilization of care
  • Factors affecting medical costs
  • Access to care and satisfaction with care
  • Return-to-work outcomes
  • Employer participation rates in the Texas workers’ compensation system
slide3
Network Participation Has Increased; However, a Relatively Small Percentage of Claims Are In Network
results from data call of top 13 insurance carrier groups

Results from Data Callof Top 13 Insurance Carrier Groups

  • As of July 1, 2008, 12 out of 13 carrier groups have contracted with or established a certified WC network (an increase from 9 in Sept 2006)
  • All carrier groups with a network have already begun offering it to policyholders and 10 out 12 carriers are offering a premium credit
  • Premium credits offered for network participation – up to 15% among carriers
  • Most participating policyholders were small and mid-sized employers
  • Carriers estimate that over 104,000 workers will be treated by networks by the end of CY 2009
total number of policyholders that participated in networks top 13 insurance carrier groups
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.

results from certified networks data call

Results from Certified Networks’ Data Call

  • Currently 33 networks are certified by TDI covering over 234 Texas counties
  • As of February 1, 2009, roughly 76,000 injured workers were treated by 18 certified networks, compared to 40,000 workers treated by 8 networks a year earlier
  • Additionally, 12,000 injured workers were treated by political subdivision network programs operated under Chapter 504, Labor Code
  • Roughly 16% of all new injuries are being treated by networks and this percentage hasn’t changed significantly in over a year
  • Most of these workers, however, are still being treated by one network; however a handful of other networks have begun increasing their participation rates
  • There are still several networks certified by TDI that do not have any insurance carrier contracts in place
slide8
Total Medical Payments (Professional and Hospital), One-Year Post Injury, Unadjusted, Injury Years 1998-2006

Note: Injury Year 2004 was excluded from this analysis due to missing data.

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

slide9
Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Unadjusted, Injury Years 1998-2006

Note: Injury Year 2004 was excluded from this analysis due to missing data.

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

slide10
Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Adjusted, Injury Years 1998-2006

Note: Injury Year 2004 was excluded from this analysis due to missing data.

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

average medical cost per claim 6 months post injury
AVERAGE MEDICAL COST PER CLAIM, 6 MONTHS POST INJURY

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Medical cost differences between non-network and Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type and type of claim differences that may exist between the groups.

slide13
Number of Workers’ Compensation Claims Reported to the Division of Workers’ Compensation, Injury Years 1998-2007

Note: These numbers include the claims that are required to be reported to DWC, including fatalities, occupational diseases, and injuries with at least one day of lost time. Medical-only claims are not required to be reported to DWC.

Source: Texas Department of Insurance, Division of Workers’ Compensation, 2008.

slide14
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.

Note: The figures presented above are adjusted for injury type and type of claim differences that may exist between the groups. Asterisks (*) indicates that the differences between the network and non-network are statistically significant.

slide15
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 excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

average number of other physical medicine services billed per claim adjusted injury years 1998 2007
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 excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

average number of spinal surgery services billed per claim adjusted injury years 1998 2007
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 excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

slide18
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.

1The 2006 figures should be interpreted with caution since the data are incomplete.

2 House Bill (HB) 2600, a workers’ compensation reform bill aimed at reducing medical costs was passed in 2001.

slide19

Percentage of MedicalServices 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 should be interpreted with caution since these number are tentative.

Note 2: House Bill (HB) 2600, a workers’ compensation reform bill aimed at reducing medical costs, was passed in 2001.

Note 3: In August 2003, the most recent professional medical fee guideline, which incorporated Medicare’s payment policies, went into effect.

slide20
Some Improvements in Workers’ Perceptions Regarding Access to Care Over Time, but Generally Workers in Networks Have Poorer Perceptions
methods injured workers reported using to select their treating doctor
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: “Selected in other manner” includes recommendations from family or friends or other coworkers, among others.

type of first non emergency treating doctor selected by injured workers
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.

percentage of injured workers who reported having problems getting medical care for their injury
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.

slide24

GETTING NEEDED CAREpercent of injured workers who reported no problem getting: a personal doctor they like · to see a specialist · necessary tests or treatment · timely approvals for care

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

Note: Differences between non-network and Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups

slide25

OVERALL SATISFACTION WITH MEDICAL CAREpercent of injured workers who indicated that they were “ extremely satisfied” with the quality of the medical care received for their work-related injury

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

Note: Differences between non-network and Texas Star, Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups

initial return to work rate
Initial Return-to-Work Rate

Percentage of Injured Workers Back At Work for the First Time

6 Months to 3 Years Post-Injury

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

Note 1: The study population includes 392,331 workers injured in 2001-2006 who also received Temporary Income Benefits (TIBs).

Note 2: Although the increases of initial RTW rates were small, they were statistically significant at the 0.01 significance level.

slide28
Mean and Median Days Off Workfor Injured Workers Who RTW At Some Point Post Injury Injury Years 2001-2005

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007.

Note 1: “Days Off Work” was defined as days from the injury date to the initial RTW date. Please note that these numbers

do not take into account any additional time off work that may have occurred after the initial RTW date.

Note 2: The analysis was based on the claimants who returned to work, and did not include those who did not return by

the end of 2007. Injury year 2006 was excluded because of insufficient data.

return to work experiences of injured workers 18 22 months post injury
Return-to-Work Experiences of Injured Workers, 18-22 Months Post-Injury

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

slide30
Percentage of Injured Workers Surveyed Who Reported Being Released to Go Back To Work by Their Doctor

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

slide31
Percent of Injured Workers Who Indicated That They Had Returned to Work At Some Point After They Were Injured

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

Note: Differences between non-network and Texas Star are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups.

slide32
Average Number of Weeks Injured Workers Reported Being Off of Work Because of Their Work-Related Injury

Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

Note: Differences between non-network and Texas Star are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups.

percentage of texas employers that are non subscribers 1993 2008
Percentage of Texas Employers That Are Non-subscribers, 1993-2008

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 - 2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

percentage of texas employees that are employed by non subscribers 1993 2008
Percentage of Texas Employees That Are Employed by Non-subscribers, 1993-2008

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 - 2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

percentage of texas employers that are non subscribers by employment size 1993 2008
Percentage of Texas Employers That Are Non-subscribers by Employment Size, 1993-2008

Note: Non-subscription estimates for 1993 were based on different employer size categories than were used in later years so they are not directly comparable.

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 -2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

percentage of texas employers that are non subscribers by industry 2006 2008 estimates
Percentage of Texas Employers That Are Non-subscribers by Industry, 2006 - 2008 Estimates

Note: Industry classifications were based on the 2002 North American Industry Classification System (NAICS)developed by the governments of the U.S., Canada and Mexico, which replaced the Standard Industrial Classification (SIC) system previously used in the U.S. As a result of this change in industry classifications, industry non-subscription rates for 2004 - 2008 cannot be compared to previous years.

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

primary reasons why subscribing employers said they purchased workers compensation wc coverage
Primary Reasons Why Subscribing Employers Said They Purchased Workers’ Compensation (WC) Coverage
  • Because employer thought having WC coverage was required by law

(25% overall; 16% of large employers)

  • Because WC coverage was available through health care networks
  • (24% overall; 28% of large employers)
  • Because of employer concerns over lawsuits
  • (14% overall; 13% of large employers)
  • Because employer needed WC coverage to obtain government contracts
  • (3% overall; no large employers)
  • Because employer thought WC insurance rates were lower

(2% overall; 3% of large employers)

  • Because employer was able to reduce its WC insurance costs through

deductibles, certified self insurance, group self-insurance or other premium

discounts (3% of large employers)

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

slide39
Primary Reasons Why Non-subscribing Employers Said They Did Not Purchase Workers’ Compensation (WC) Coverage
  • Because employer thought WC insurance premiums were too high

(26% overall; 49% of large employers)

  • Because employer had too few employees (26% overall)
  • Because employer was not required by law to have WC insurance (11% overall)
  • Because employer thought medical costs in the WC system were too high

(4% overall; 13% of large employers)

  • Because employer had few on-the-job injuries

(9% overall; 10% large employers)

Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

upcoming research projects
Upcoming Research Projects
  • Updated Network Report Card (to be published in Sept)
  • Update return-to-work rates (late summer)
  • Continue monitoring network participation by employers and workers
  • Analyze preliminary impact of ODG treatment guideline (early fall)
  • Survey nonsubscribing employers about availability of data and methods to evaluate the cost and quality of nonsubscriber programs
workers compensation research and evaluation group reg
Workers’ Compensation Research and Evaluation Group (REG)

Find Research Reports on TDI Website:

  • http://www.tdi.state.tx.us/wc/regulation/roc/index.html

Contact REG

  • WcResearch@tdi.state.tx.us
  • DC Campbell at 322-3566 or Amy Lee at 804-4410