Today’s issue of WorkCompRecap features WCRI’s recent release of its CompScope Medical Benchmarks for California report, which found medical payments per claim were typical of other states, showing the effect of comprehensive reform legislation.
WCRI attributed the changes to multiple policy initiatives, including Senate Bill (SB) 863, a drug formulary, and two fraud-fighting measures. Medical payments per claim have been stable overall since 2015, after decreasing with the enactment of SB 863 in 2013. Other key findings included that the percentage of claims with Ambulatory surgery center facility services and the proportion of claims with hospital outpatient facility services decreased, possibly due to a decrease in surgery rate. Average prescription payments per claim, which were higher than typical for 2013/2016 claims, also became the lowest of the study states for 2016/2019 claims.
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