WCRI conference report – how’s Texas doing?

I’m attending the annual WCRI meeting in Boston today and tomorrow, and will be blogging from the meeting. For those not up on all things workers comp, the workers comp research institute is, along with NCCI and the CWCI, among the leading research and education organizations dealing with workers comp.
Perhaps the most important topic at WCRI this year is the evaluation of recent reform initiatives in California and Texas.
Here are the highlights from Texas – numbers are not included as the results are preliminary.

In the Lone Star State, physical medicine visits per claim decreased after passage of reform in 2003, with a significant chunk of that drop due to reductions in chiro visits. This reversed a trend tof steady increases that had been going on for a few years.
Even after the reduction in utilization, Texas still has the highest number of chiro visits per claim among the 14 states analyzed by WCRI. The number of claims that have chiro services also dropped, albeit slightly.
Satisfaction rates increased, perhaps because the number of physicians willing to take workers comp patients rose significantly. This phenomena appeared to be independent of the reform implementation in 2003, and may be related to the increase in the overall number of physicians working in Texas. One hypothesis is docs found Texas a more attractive place to practice after the state passed medical malpractice reforms.
The fee schedule also increased, at least in terms of the percentage of Medicare paid to providers. However, Medicare’s changes in the RBRVS formula resulted in decreased compensation (in real terms) for surgeries and some other services, while reimbursement for cognitive services (aka evaluation and management, or E&M) jumped significantly.
The frequency of surgeries in workers comp dropped after reform was implemented. There are several possible contributors to this. Interestingly, spinal surgeries had to be precerted after 2003, and this may have contributed to the overall, but relatively modest, decline in the number of surgeries reported. Remember, there were more surgeons practicing in Texas after reform, but surgical reimbursement rates dropped.
Another potential contributing factor may be the net reduction in reimbursement for surgeries – compared to other states, reimbursement rates are somewhat lower for surgery in Texas.
Interestingly, although claimants continued to report problems with getting access to care post-reform, but medical costs and disability outcomes appeared to improve.
The net? Texas is looking better after the 2003 reforms, but the decrease in claimant satisfaction rates is cause for concern in some circles.