Costs of Medical Care per Claim for Injured Workers in California Moderated Prior To Reforms Being Implemented

This WCRI study, CompScope™ Medical Benchmarks for California 14th Edition, reviews the reform provisions that are related to medical reimbursement and treatment, as well as the medical-legal process, and addresses the potential impact of some of the key reform provisions on price and utilization of medical services.

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Future editions of CompScope™ Medical Benchmarks will monitor the collective impact of the reform provisions, as well as behavioral changes by system participants as they adapt to the reforms.

Cambridge, MA (PRWEB) May 12, 2014

A recent study from the Workers Compensation Research Institute (WCRI) looked at the potential impact of recent reform legislation on price and utilization of medical services in the California workers’ compensation system.

The WCRI study, CompScope™ Medical Benchmarks for California 14th Edition, provides baseline data for monitoring the impact of the California reform legislation (Senate Bill 863), which took effect on January 1, 2013, as several key provisions of it apply to medical reimbursement and treatment as well as the medical-legal process.

According to the study, the potential impact from the transition to a resource-based relative value scale (RBRVS) fee schedule would likely shift payments from specialty care to primary care, based on experiences from other states WCRI has studied. The study reported that in Maryland and Georgia, the prior transition to the RBRVS-based fee schedules led to increases in prices paid for office visits and physical medicine, and decreases in prices paid for surgical services.

“Lessons from other states may be instructive on the potential implications of the expected change to utilization, provider behavior, and access to care following the price changes,” said Ramona Tanabe, WCRI deputy director and counsel. “Future editions of CompScope™ Medical Benchmarks will monitor the collective impact of the reform provisions, as well as behavioral changes by system participants as they adapt to the reforms.”

The study shows the growth in medical payments per claim in California had moderated to 3 percent per year in 2010 and 2011, following previous increases of 8 percent per year since 2005. The moderating trend stemmed from the stabilization in utilization of nonhospital services and little change in prices paid for professional services. Hospital payments per inpatient episode continued to grow rapidly from 2006 to 2011.

The WCRI study also shows that before the reforms, medical-legal expenses per claim in California grew rapidly and were among the highest of the 16 states in the study. Click on the following link to purchase a copy of this study: http://www.wcrinet.org/studies/public/books/csmed14_CA_book.html.

The Cambridge-based WCRI is recognized as a leader in providing credible, high-quality, and objective information about public policy issues involving workers' compensation systems.

ABOUT WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.


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  • Andrew Kenneally
    Workers Compensation Research Institute
    +1 (617) 661-9274 Ext: 257
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