Report: Workers’ Comp Medical Payments Fell in California After Reforms

October 25, 2018

Medical payments per claim with more than seven days of lost time in California decreased after the implementation of workers’ comp reform for claims with experience through March 2017, according to a recent study by the Workers Compensation Research Institute.

The state passed sweeping workers’ comp reform with Senate Bill 863, which went into effect in 2013.

“Most other states WCRI studied experienced increases or stable trends over the same period,” Ramona Tanabe, WCRI’s executive vice president and counsel, said in a statement.

The study, CompScope Medical Benchmarks for California, 19th Edition, continued to monitor the changes in medical payments, prices, and utilization in the California workers’ comp system in the era post-SB 863. The study also compared these metrics of medical costs and care in California with 17 other states before and after SB 863.

“The decrease in payments per claim for nonhospital services was the main driver of the decrease in medical payments per claim post-SB 863,” said Tanabe, “another factor was the decrease in frequency of hospital care usage in California.”

Following are among the study’s other findings for California:

  • The transition to the resource-based relative value scale based fee schedule led to different changes in prices paid for different types of professional services. Utilization of most types of nonhospital services remained stable or had small decreases.
  • Ambulatory surgery center facility payments per claim decreased following the fee schedule reduction, and then remained fairly stable. The percentage of claims with ASC facility services also decreased.
  • Prescription payments per claim with prescriptions decreased at double-digit rates.

The group has more on the report at its website.

WCRI is an independent, not-for-profit research organization based in Cambridge, Mass.

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