A recent report reveals a significant 51.1% decrease in inpatient hospitalizations within the California workers’ compensation system from 2012 to 2022.

This decline stems from various factors, including reduced claim numbers, advancements in technology, changes in Medicare regulations permitting more outpatient procedures, the cessation of redundant payments for spinal surgery hardware, and the expansion of evidence-based protocols for spinal fusions and related surgeries, as highlighted in an analysis by the California Workers’ Compensation Institute.

Utilizing data encompassing 28.7 million inpatient hospital stays spanning from 2012 to 2022, collected by the California Department of Health Care Access and Information, the CWCI scrutinized the utilization of inpatient services and treatments under workers’ comp, Medicare, Medi-Cal, and private insurance.

The study revealed a notable drop in workers’ comp inpatient stays from 21,505 in 2012 to 10,516 in 2022. Furthermore, between 2021 and 2022, these hospitalizations decreased by 5.6%, resulting in a cumulative reduction of 51.1% over the past 11 years.

Comparatively, hospital stays funded by private insurance decreased by 23.5% during the same period, whereas Medicare hospitalizations only decreased by 1.4%. Conversely, Medi-Cal-funded stays surged by 45.7%, attributed to increased Medi-Cal enrollments post the Affordable Care Act in 2014, according to the CWCI analysis.

The CWCI analysis underscores that the decline in workers’ comp inpatient stays extends over a decade and is fueled by fluctuations in work injury claims, the implementation of utilization review and independent medical review programs mandating evidence-based treatment standards, and a significant reduction in spinal fusion procedures.

These findings suggest that numerous factors persist in containing the volume of workers’ comp inpatient stays. Unlike other systems where inpatient hospitalizations rebounded after a sharp decline in 2020, attributed to the pandemic’s onset, there are exceptions such as inpatient spinal fusions, which increased by 5.0% from 2020 to 2022. This rise drove spinal fusion hospital stays to comprise 18.7% of all workers’ comp inpatient discharges in 2022, the highest proportion since 2016, according to CWCI.