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Average California medical payment stable since 2015


Average medical payments per claim with more than seven days of lost time have been stable in California since 2015, according to a study by the Workers Compensation Research Institute.

Medical payments in California were 11% lower than the 18-state median for 2017 claims evaluated as of 2020.

“One area where California really stands out in this study is prescription drugs,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Since 2013, California prescription payments per claim with prescriptions have decreased very rapidly, more than any of the other study states, which likely reflects several factors.”

WCRI reports that the average nonhospital payment per claim has been fairly stable since 2015, decreasing 1% per year on average for claims at 12 months of experience. Payments per claim for key nonhospital services were mostly stable after 2017.

The average prescription payment per claim with prescriptions has decreased rapidly since 2013, according to WCRI.

The changes “may be related to the introduction of independent medical review by SB 863, changes to the Medi-Cal fee schedule, the application of treatment guidelines, the impact of the drug formulary, growing attention to the use of opioids in workers compensation, and the practice of disallowing physician dispensing in some medical provider networks,” WCRI said.

WCRI also reports that payments per claim for hospital services grew moderately from 2015 to 2019, but the percentage of claims with hospital care decreased.

“Results from this study include experience on claims through March 2020, at the very beginning of the coronavirus pandemic,” Ms. Tanabe said.

WorkCompCentral is a sister publication of Business Insurance. More stories here.