This 20th edition CompScope™ Medical Benchmarks study for California helps policymakers and other stakeholders in the system identify current cost drivers and emerging trends in payments, prices, and utilization of medical services provided for treating workers injured on the job. This study examines medical payments, prices, and utilization for various types of services by nonhospital and hospital providers in California and compares California with 17 other states. It also examines how these metrics of medical payments and care have changed, mainly from 2012 to 2017. We analyzed claims with experience through 2018 for injuries up to and including 2017, and in some cases, we used a longer time frame to supply historical context.

California implemented multiple policy changes in recent years. Senate Bill (SB) 863, a comprehensive reform legislation, went into effect in January 2013. Results in this report reflect the state’s system performance five years after the implementation of SB 863. Assembly Bill (AB) 1244 and SB 1160, two major fraud-fighting measures, were enacted in January 2017. The data in this study reflect up to 15 months of experience after the passage of these bills. The drug formulary required by AB 1124 became effective in January 2018, and data in this report may reflect some early impact of this policy initiative. In addition, during the analysis period of this study, California went through multiple medical fee schedule updates for hospital outpatient department and ambulatory surgery center services, and nonhospital professional services. These regulatory changes are also potential factors influencing the results discussed in this report.

CompScope™ Medical Benchmarks for California, 20th Edition. Rui Yang. October 2019. WC-19-28.

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