California Workers’ Comp Study Tracks Inpatient Care Utilization Trends

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A new study shows that after across-the-board declines in California inpatient hospitalizations during the COVID-19 crisis of 2020, the number of inpatient stays paid under Medicare, Medi-Cal, and private coverage began to rebound in 2021.

However, the number of workers’ compensation hospitalizations fell an additional 5.7%, according to the study by the California Workers’ Compensation Institute.

The CWCI study compares the use of inpatient services and procedures in different systems using data state compiled on more than 35.3 million hospital stays with 2012 through 2021 discharge dates.

The 2021 decline in workers’ comp hospitalizations brought the total decline over the past decade to 48.1%, more than triple the 10-year decline of 15.0% noted for hospital stays paid under private coverage, while hospitalizations paid under Medicare were only down 5.2% and those paid by Medi-Cal increased by 11.7%, according to the CWCI.

Workers’ comp is by far the smallest program analyzed, representing less than 0.5 % of the California inpatient stays over the 10-year study period, and just 0.3 % in 2021.

Most workers’ comp hospital stays were for the treatment of musculoskeletal and connective tissue disorders (between 58.1% and 66.0% of the stays since 2012), but COVID’s impact was evident in the recent data, as the percentage of injured worker inpatient stays for the treatment of diseases and disorders of the respiratory system nearly tripled from 2.6% in 2019 to 7.4% in 2020 and remained at an elevated level (7.0%) in 2021, according to CWCI.

A review of the hospital stays for diseases and disorders of the respiratory system found that half were for respiratory infections and inflammation, though injured worker hospitalizations in that diagnostic category included a larger share of collapsed lungs or major chest traumas, the study shows.

Surgical stays are far more prevalent in workers’ comp than in other systems, with the data showing they accounted for more than 2/3 of injured workers’ inpatient hospitalizations in 2021, versus 24.7% for Medicare, 21.1% for Medi-Cal, and 31.5% for private coverage. Workers’ comp inpatient surgeries continue to be led by spinal fusions (17.6% of the 2021 surgeries) and major joint replacements (10.7%), the data shows.

Despite a sharp decline in workers’ comp spinal fusions (-59.1% since 2012), they are still far more prevalent among the injured worker inpatient population than among inpatients covered by Medi-Cal (0.6%), Medicare (1.3%); or private coverage (1.8%). As for workers’ comp joint replacement surgeries, the study that 87.9% of all injured workers who underwent knee or hip replacements in 2021 were diagnosed with primary osteoarthritis, which tends to develop from mechanical wear and tear, structural degeneration, and joint inflammation, rather than from an acute, direct trauma to the joint associated with a specific injury.

More detailed findings from the CWCI study were released in a Research Update Report, “Trends in the Utilization of Inpatient Care in California Workers’ Compensation.” CWCI members and subscribers can access the report at the institute’s website.