The Workers’ Compensation Insurance Rating Bureau of California has released its Physical Medicine Treatments and Their Impact on Opioid Use and Lost Time in California Workers’ Compensation study. The study reveals insights into the overall trends and patterns of physical medicine treatment cost and utilization. It quantifies the potential substitution between physical medicine and opioid use early in the life of a claim and their effects on lost time on the job.

Starting in 2014, the four-year transition to the Resource-Based Relative Value Scale (RBRVS) physician fee schedule in California’s workers’ compensation system increased reimbursements for most types of primary care treatment.

Since then, physical medicine (including physical therapy [PT], chiropractic care and acupuncture), as a leading primary care treatment for injured workers, has experienced a continuous increase in the paid per claim at 8% annually in the workers’ compensation system without a proportional increase in the level of utilization.

Recent legislation has also encouraged medical providers to treat injured workers in the California workers’ compensation system with non-opioid drugs and physician services. For example, some provisions in Senate Bill No. 1160 (SB 1160), effective in January 2018, remove the requirement of prospective utilization review (UR) for certain medical services, such as physical medicine, that are provided within the first 30 days of the injury.

Meanwhile, the number of opioid prescriptions as well as the payments for opioids per claim has plummeted since 2012.

Key findings in the study include:

— The average medical payment for physical medicine continued to rise from 2013 through 2018, contributing to a growing proportion of the total medical paid per claim as well as of the medical paid for physician services per claim.
— Overall, soft tissue injury claims involving physical therapy (PT) during the first 30 days of the initial medical visit were less likely to involve opioid use within one year of the injury, compared to similar claims without early PT.
— The impact of early PT on initiation of opioid use varies over time; particularly, between 2015 and 2017, soft tissue claims involving early PT were significantly less likely to involve opioid use.
— Among soft tissue claims involving opioid use, those with early PT had significantly lower doses of opioids prescribed within one year of the injury than similar claims without early PT.
— Comparing claims with similar characteristics but different timing of utilizing PT, those with early PT were significantly less likely to have a lost time component.

The full study is available in the Research section of the WCIRB website.