Posted Date: May 10, 2023
NCCI’s Under the Microscope: Medical Trends in Comp presentation introduces an analytic method to deconstruct changes in medical utilization over time into contributions from changes in injury mix and medical treatment for physician services. The Under the Microscope: Medical Trends in Comp Guide provides a slide-by-slide examination of the key insights, data sources, and background underlying the presentation.
As you review the information contained in this Guide, it may be useful to keep in mind the following main takeaways that NCCI’s Under the Microscope: Medical Trends in Comp presentation highlighted:
We hope you find the Under the Microscope: Medical Trends in Comp Guide a beneficial and informative resource.
This chart shows the change from the prior year in physician payments per claim for service years 2013–2022.
Source: NCCI’s Medical Data Call (MDC)
Each chart shows the change from the prior year for service years 2013–2022 for price and utilization of physician services. Price indices derive directly from utilization and paid cost: Utilization x Price = Paid Cost.
Source: NCCI’s Medical Data Call (MDC)
NCCI’s Utilization = CMS Relative Value Units x NCCI’s conversion factor.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the average physician utilization per claim for the indicated service years.
Source: NCCI’s Medical Data Call (MDC)
This chart provides a breakdown of the change in physician service utilization per claim over the indicated time periods.
Source: NCCI’s Medical Data Call (MDC)
Source: NCCI’s Medical Data Call (MDC)
The chart shows this deconstruction for the total period and then for each of the subperiods. The stacked bars express the total change in utilization of physician services as the sum of contributions via the four factors: body system, diagnosis, major surgery, and medical service intensity.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the medical service intensity change for the indicated periods.
Source: NCCI’s Medical Data Call (MDC)
NCCI deconstructed the contribution via medical service intensity into contributions from specific medical services: physical therapy for claims with no major surgery, physical therapy for claims with major surgery, and all other physician services. The chart shows the contribution analysis for the indicated periods.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the share of claims for each of the body systems, and the contribution of each body system to the physician service utilization over the period 2012–2022.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the contribution of change in diagnosis, frequency of major surgery given diagnosis, and the change in physical therapy to the change in utilization for shoulder claims. In terms of shoulder injuries, workers most commonly experience strains and sprains (which tend to be relatively minor) and rotator cuff tears (more severe and more likely to require surgery).
Source: NCCI’s Medical Data Call (MDC)
This chart deconstructs the contribution of changes in shoulder injuries to overall physician service utilization per claim.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the contribution of change in diagnosis, frequency of major surgery given diagnosis, and the change in physical therapy to the overall change in utilization for leg claims. Leg injuries encompass a wide range of diagnoses. Sprains and strains are most common and less severe; fractures and ligament tears are less common but more severe.
Source: NCCI’s Medical Data Call (MDC)
The two main drivers for leg injuries are a larger share of injuries coming from this body system, and more intensity of medical treatment per claim, predominantly more physical therapy.
Leg injuries contributed +6% to changed utilization of physician services from 2012 to 2022. That’s virtually identical to the contribution from Shoulder injuries.
This chart deconstructs the contribution of changes in leg injuries to overall physician service utilization per WC claim.
Source: NCCI’s Medical Data Call (MDC)
The chart shows the contribution of change in diagnosis, frequency of major surgery given diagnosis, and the change in physical therapy to the overall change in utilization for back/neck claims.
Source: NCCI’s Medical Data Call (MDC)
The decrease in claim share is the biggest driver of physician utilization changes from the back and neck injuries.
For medical treatment, a small decrease in the surgery rate is offset by a small increase in service intensity.
This chart deconstructs the contribution of changes in back and neck injuries to overall physician service utilization per claim.
Source: NCCI’s Medical Data Call (MDC)
This chart summarizes the decomposition of physician service utilization into its components.
Source: NCCI’s Medical Data Call (MDC)
This chart describes the injury mix contribution to utilization.
Source: NCCI’s Medical Data Call (MDC)
This chart deconstructs the medical treatment contribution to utilization.
Source: NCCI’s Medical Data Call (MDC)
Diagnosis Group | Body System | Examples |
---|---|---|
Nerve Injury Upper Extremity | Arm |
Lesion of radial nerve, unspecified upper limb (G56.3) Lesion of ulnar nerve (G56.2) |
Carpal Tunnel Syndrome | Hand/Wrist |
Carpal tunnel syndrome (G56.0) Carpal tunnel syndrome, bilateral upper limbs (G56.03) |
Hand/Wrist Fracture | Hand/Wrist |
Displaced fracture of distal phalanx of finger (S62.63) Fracture of hook process of hamate [unciform] bone (S62.15) |
Minor Arm Injury | Arm |
Other superficial injuries of forearm (S50.8) Injury of other extensor muscle, fascia and tendon at forearm level (S56.5) |
Cervical Spine Degeneration | Neck |
Spinal stenosis, occipito-atlanto-axial region (M48.01) Spondylolysis, occipito-atlanto-axial region ( M43.01) |
Elbow Forearm Fracture | Arm |
Fracture of upper end of ulna (S52.0) Fracture of shaft of radius (S52.3) |
Lumbosacral Intervertebral Disc Disorders | Lumbar Spine |
Intervertebral disc disorders with myelopathy, lumbar region (M51.06) Other thoracic, thoracolumbar and lumbosacral intervertebral disc displacement (M51.2) |
Low Back Pain | Lumbar Spine |
Sacroiliitis, not elsewhere classified (M46.1) Contusion of lower back and pelvis (S30.0) |
Lumbar Radiculopathy/Sciatica | Lumbar Spine |
Sciatica (M54.3) Lumbosacral root disorders, not elsewhere classified (G54.4) |
Ankle Fracture | Ankle/Foot |
Fracture of lateral malleolus (S82.6) Nondisplaced fracture of medial malleolus of unspecified tibia (S82.56) |
Neck Pain | Neck |
Dislocation and sprain of joints and ligaments at neck level (S13) Superficial injury of other specified parts of neck (S10.8) |
Cervical Disc Disorders | Neck |
Cervical disc disorder with radiculopathy (M50.1) Cervical disc disorder, unspecified (M50.9) |
Crush Injury, Hand/Wrist | Hand/Wrist |
Crushing injury of other and unspecified finger(s) (S67.1) Crushing injury of left hand (S67.22) |
Adhesive Capsulitis, Shoulder | Shoulder |
Adhesive capsulitis of shoulder (M75.0) Adhesive capsulitis of left shoulder (M75.02) |
Eye Injury Minor | Eye |
Injury of conjunctiva and corneal abrasion without foreign body (S05.0) Injury of conjunctiva and corneal abrasion without foreign body, right eye (S05.01) |
Other disorders of eye and adnexa | Eye |
Other disorders of eye and adnexa (H57) Miosis (H57.03 ) |
Conjunctivitis | Eye |
Conjunctivitis (H10) Chronic conjunctivitis (H10.4) |
Head Injury Minor | Head |
Superficial injury of head (S00) Superficial injury of lip and oral cavity (S00.5) |
Shoulder Impingement Syndrome | Shoulder |
Impingement syndrome of shoulder (M75.4) Impingement syndrome of right shoulder (M75.41) |
Minor Hip Injuries | Hip/Pelvis |
Pain in hip (M25.55) Blister (nonthermal) of hip (S70.2) |
Concussion/Minor Traumatic Brain Injury | Head |
Concussion (S06.0) Concussion with loss of consciousness of unspecified duration (S06.0X9) |
Open wound of knee and lower leg | Leg |
Open wound of lower leg (S81.8) Laceration without foreign body, left lower leg (S81.812) |
Open wound of ankle, foot and toes | Ankle/Foot |
Open wound of toe with damage to nail (S91.2) Laceration without foreign body of ankle (S91.01) |
Knee and Lower Leg Injuries | Leg |
Fracture of shaft of tibia (S82.2) Oblique fracture of shaft of fibula (S82.43) |
Synovitis/Tenosynovitis, Hand/Wrist | Hand/Wrist |
Crepitant synovitis (acute) (chronic) of hand and wrist (M70.0 ) Radial styloid tenosynovitis (M65.4) |
Traumatic Amputation, Hand/Wrist | Hand/Wrist | Partial traumatic transphalangeal amputation of other and unspecified finger (S68.62) Traumatic amputation of wrist, hand and fingers (S68) |
Lumbar Spine Degeneration | Lumbar Spine |
Spondylolysis, lumbosacral region (M43.07) Congenital spondylolisthesis (Q76.2) |
Minor Shoulder Injury | Shoulder |
Contusion of shoulder (S40.01) Contusion of left shoulder (S40.012) |
Arm Fracture | Arm |
Fracture of lower end of radius (S52.5) Fracture of radial styloid process (S52.51) |
Inguinal Hernia | Abdomen |
Inguinal hernia (K40) Bilateral inguinal hernia, with gangrene, recurrent (K40.11) |
Open wound of elbow and forearm | Arm |
Open wound of elbow and forearm (S51) Open wound of forearm (S51.8) |
Degenerative Shoulder | Shoulder |
Loose body in shoulder (M24.01) Post-traumatic osteoarthritis, shoulder (M19.11) |
Minor Lower Leg Injury | Leg |
Blister (nonthermal) of lower leg (S80.82) Other specified injuries of left lower leg (S89.82) |
SLAP Lesion | Shoulder | Superior glenoid labrum lesion (S43.43) |
Minor Elbow Injury | Elbow |
Contusion of elbow (S50.0) Olecranon bursitis, unspecified elbow (M70.20) |
Cervical Radiculopathy/Myelopathy | Neck |
Other spondylosis with myelopathy, occipito-atlanto-axial region (M47.11) Cervical root disorders, not elsewhere classified (G54.2) |
Upper Back Pain | Chest/Upper Torso |
Sprain of ligaments of thoracic spine (S23.3) Sprain of ligaments of thoracic spine, initial encounter (S23.3XXA) |
Knee Internal Derangement - Cruciate Ligament Tear | Knee |
Sprain of cruciate ligament of knee (S83.5) Sprain of posterior cruciate ligament of right knee (S83.521 ) |
Rotator Cuff Tear | Shoulder |
Shoulder lesions (M75) Other shoulder lesions (M75.8) |
Shoulder Upper Humerus Fracture | Shoulder |
Fracture of scapula (S42.1) Fracture of other part of scapula (S42.19) |
Lower Extremity Sprain/Strain | Leg |
Injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level (S86.2) Other injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg ( S86.292) |
Head/Face Wound | Head |
Open wound of unspecified part of head (S01.9) Laceration without foreign body of unspecified part of head, initial encounter (S01.91XA) |
Head Injury NOC | Head |
Other and unspecified injuries of head (S09) Unspecified injury of face and head (S09.9) |
Dorsalgia | Lumbar Spine |
Dorsalgia (M54) Radiculopathy (M54.1) |
Minor Ankle/Foot Injuries | Ankle/Foot |
Superficial injury of ankle, foot and toes (S90) Contusion of foot (S90.3) |
Knee Internal Derangement - Meniscus Injury | Knee |
Tear of meniscus, current injury (S83.2) Bucket-handle tear of medial meniscus, current injury (S83.21) |
Bicipital Tendinitis | Shoulder |
Bicipital tendinitis (M75.2) Bicipital tendinitis, unspecified shoulder (M75.20 ) |
Muscle/Tendon Injury, Hand/Wrist | Hand/Wrist | Injury of unspecified muscle, fascia and tendon at wrist and hand level (S66.9) Strain of unspecified muscle, fascia and tendon at wrist and hand level (S66.91) |
Hip/Pelvis Fracture/Major Trauma | Leg |
Fracture of lesser trochanter of femur (S72.12) Displaced fracture of lesser trochanter of left femur (S72.122 ) |
Minor Knee Injury | Knee |
Sprain of collateral ligament of knee (S83.4) Sprain of unspecified collateral ligament of unspecified knee (S83.409) |
Minor Hand/Wrist Injuries | Hand/Wrist |
Other and unspecified sprain of wrist (S63.5) Sprain of carpal (joint) (S63.51) |
Dislocation and sprain of joints and ligaments of thorax | Chest/Upper Torso |
Dislocation and sprain of joints and ligaments of thorax (S23) Subluxation and dislocation of thoracic vertebra (S23.1) |
Elbow Epicondylitis | Elbow |
Medial epicondylitis (M77.0) Medial epicondylitis, right elbow (M77.01) |
Knee Degenerative/Overuse Injuries | Knee |
Chondromalacia patellae (M22.4) Chondromalacia, knee (M94.26) |
Minor Thigh Injuries | Leg |
Contusion of thigh (S70.1) Strain of quadriceps muscle, fascia and tendon (S76.11) |
Heel/Midfoot Fracture | Ankle/Foot |
Intraarticular fracture of calcaneus (S92.06) Fracture of calcaneus (S92.0) |
Foreign body on external eye | Eye |
Foreign body on external eye (T15) Foreign body in conjunctival sac (T15.1) |