Workers comp changes reducing payments to California surgery centers

Recent workers compensation reforms in California have reduced fees paid to ambulatory surgery centers by more than one-quarter, according to a study released this week by the Workers' Compensation Insurance Rating Bureau of California and the California Workers' Compensation Institute.

S.B. 863, California's most recent workers comp reform bill, was signed into law in 2012 by California Gov. Jerry Brown and began taking effect Jan. 1, 2013. The bill limited the maximum fees that could be paid to ambulatory surgery centers — a driver of increasing workers comp medical costs in California — to 80% of the fees paid by Medicare for similar services.

Medical fees paid to California ambulatory surgery centers fell to $2,443 per episode in 2013, down nearly 26% from $3,291 per episode in 2012, according to Oakland, Calif.-based CWCI and San Francisco-based WCIRB.

The groups defined an episode as procedures and ancillary services provided by a surgical center on a specific claim and a specific date of service.

The net payment per procedure performed by California ambulatory surgery centers fell to $632 in 2013, down 28% from $878 per procedure in 2012, the study said.

“Such results suggest that thus far, the change in the ASC fee schedule has achieved its intended objective of reducing one aspect of workers compensation medical costs,” according to the study released Wednesday.