A Workers Compensation Research Institute (WCRI) study reveals that, as of March 2023, medical payments per workers’ compensation claim in California were 10% below the median of a 17-state sample.
Titled CompScope Medical Benchmarks for California, 25th Edition, the report assesses med payment, pricing, and utilization in California compared to 16 other states. It covers claims data up to March 2023 and offers insights into the pandemic’s effects on non-COVID-19 workers’ compensation claims during its first three years. This analysis includes 60% of all workers’ compensation benefits paid nationwide.
According to WCRI’s vice president of research, Sebastian Negrusa, California’s ranking in medical payments per claim is influenced by several offsetting factors. The state has a higher share of claims involving workers who missed more than seven days of work than the average state. However, the medical payments for these claims rank among the lowest studied.
The report also highlights trends in key metrics over time:
– Stability in Payments: From 2017 to 2022, payments per claim for most key professional services remained stable. Except for a recent increase in office visit payments.
– Price Increases and Utilization Declines: Prices paid for professional services rose between 2020 and 2022. However, a decrease in service utilization largely countered this increase.
– Declining Medical Services: The reduction in utilization primarily affected major surgeries, facility services, and inpatient care.
Conclusion
The report notes stable payments for most services but also a decline in utilization, particularly in major surgeries and inpatient care. As the pandemic’s impact continues to shape healthcare, this analysis provides valuable insights for policymakers and stakeholders to better understand and manage California’s workers’ compensation system.
