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Stephanie Goldberg

California workers comp reform could lead to mixed pricing results: Study

May 13, 2014 - 2:57pm


California workers compensation reforms could lead to increased prices for office visits and physical medicine and decreased prices for surgeries based on trends from other states, according to a Workers Compensation Research Institute study.

Prior to California's 2012 workers compensation reforms, the state's average medical-legal expenses per claim were the highest of 16 states studied by the institute.

At nearly $3,200 per case, medical-legal expenses per claim in California were nearly 120% higher than the 16-state median for 2009 claims with three years of experience, the Cambridge, Massachusetts-based WCRI said Monday.

The WCRI defined medical-legal expenses as including medical-legal evaluations and reports, independent medical examinations, depositions and medical expert fees.

According to the report, medical payments per claim rose on a yearly basis between 2006 and 201 before the state's most recent workers comp reform bill — S.B. 863 — was signed into law Sept. 18, 2012.

WCRI's study aimed to show the reform bill's impact on price and utilization of medical services in California's workers comp system, according to a statement. The bill took effect on Jan. 1, 2013.

Among several provisions, the bill established new fee schedules for various California workers comp medical services and service providers. Based on the experiences of other states, such as Georgia and Maryland, the study said the new fee schedules could increase prices paid for office visits and physical medicine and decrease prices paid for surgeries.

In 2012, California office visit prices for workers comp claims were among the lowest of 25 states studied, WCRI said.

The study examined more than nine million claims from the 16 states included in the study: Florida, Arkansas, Indiana, Virginia, North Carolina, Iowa, Louisiana, Minnesota, Massachusetts, Pennsylvania, Wisconsin, Texas, California, Illinois, Michigan and New Jersey.

 



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