San Francisco, CA – The WCIRB recently released the California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment transaction data from calendar year 2014 to calendar year 2013. WCIRB researchers used reported medical payment data representing more than 90% of the California workers’ compensation insurance market.
Among the key findings of the report are:
- Industry-wide medical payments based on WCIRB individual medical bill transactions decreased by $100 million (3.7%) in 2014 compared to 2013. This decrease occurred despite a minimal change in the number of claims in 2014. As a result the medical paid based on individual medical bill transactions per claim declined by 5%.
- The adoption of the RBRVS-based provider fee schedule in January 2014 was one factor in these savings. This schedule covered approximately 40% of all costs, or $1 billion per year. This new schedule shifted payment shares from specialists to primary care providers. The impact of RBRVS was reflected in 2014 changes in payment shares for types of provider, places of service, mix of paid procedures and the fastest growing procedures.
- Several services not affected by RBRVS also experienced declines in 2014 compared to 2013. Inpatient and outpatient payments as well as payments for medical supplies showed declines, both in share of payments and paid per transaction. Total pharmacy payments, including spending on opiates, dropped somewhat in 2014. However, the cost per drug transaction increased, largely driven by the frequent use of brand rather than generic drugs.
- Exceptions to the overall payment declines were Medical Legal and lien costs. Both categories increased in payment shares and costs per transaction in calendar year 2014 compared to calendar year 2013. The rise in Medical Legal costs is largely due to the continued increase in higher complexity reports. The increase in lien costs is likely attributable to improved reporting of those costs in the WCIRB’s individual medical bill transaction data set.
The full Report is available here: WCIRB: California Workers’ Compensation Aggregate Medical Payment Trends (PDF).
Source: CA WCIRB