The Department of Industrial Relations and its Division of Workers’ Compensation posted a new progress report on the department’s Independent Medical Review program. IMR is the medical dispute resolution process that uses medical expertise to obtain consistent, evidence-based decisions and is one of the most important components of Senate Bill 863, the landmark 2012 workers’ compensation reform. According to the report “IMR continues to provide expedient, efficient resolution of disputes over medical necessity in the California workers’ compensation system.”

The 2017 Independent Medical Review Report: Analysis of 2016 Data provides an evaluation of the program during the third complete year in which IMR data was available for all dates of injury. The report features comparisons with figures provided in the previous report, the 2016 Independent Medical Review Report: Analysis of 2014 – 2015 Data.

Highlights of the report include:

– The average number of days from when the IMR case is assigned to when it is decided was cut nearly in half between the beginning and end of the year, from 24 days to 14 days.
– The number of eligible applications and the number of cases decided increased slightly from the year prior.
– Overall, the IMRO overturned 8.4% of the utilization review decisions that denied treatment requests made by physicians treating injured workers.
– Case decisions are extremely similar when comparing several demographic categories, including the injured workers’ date of injury, their representation status, and the geographic region of their residence. Other findings:
– At least 13,000 IMR decisions are issued every month.
– The monthly total for number of applications deemed ineligible has been cut by nearly one-third between January and December of 2016.
– More than 40% of all treatment requests are for pharmaceuticals. Three of every 10 pharmaceutical evaluations are for opioids.
– The majority of physician reviewers who provided decisions in 2016 were licensed in California.
– Nearly two-thirds of all IMR determinations were decided by Physical Medicine & Rehabilitation, Occupational Medicine and Family Practice specialists.

An IMR result search tool was added to the DWC website to further promote community education and transparency of the process. Over a half-million IMR decisions are posted on the site, and this tool enables members of the public to search case decisions using specific criteria, such as the category of treatment request and the date(s) of injury. The site received over 21,000 visits in 2016.

Maximus Federal Services successfully launched a pilot of the IMR portal for electronic filing of IMR cases. Several tests were completed in 2016 to ensure a smooth transition to a live site in early 2017.

In October 2016, the DWC launched its first online Physician Education Module, through which physicians and other interested parties can learn to use the MTUS to maximize patient recovery, function, and return to work. Health-care providers can obtain one hour of continuing education credit at no cost.

The progress report is posted on the DIR website.