CompScope™ Medical Benchmarks for California, 24th Edition

By William Monnin-Browder

October 5, 2023 Related Topics: Medical Costs, CompScope™ Medical Benchmarks

This study can help policymakers and other stakeholders in the workers’ compensation system to identify cost drivers and emerging trends in payments and utilization of medical services among nonhospital and hospital providers. In this report, we examine medical payments, prices, and utilization in California and compare them with 16 other states.

The study also examines how these metrics of medical costs and care have changed, mainly from 2016 to 2021. We analyze claims with experience through 2022 for injuries up to and including 2021. In some cases, we use a longer time frame to supply historical context for key metrics.

The results we report include non-COVID-19 claims from the first and second years of the COVID-19 pandemic (March 2020 through September 2021). The study, therefore, provides insights into how the pandemic likely impacted non-COVID-19 workers’ compensation claims in the first two years of the pandemic.

California also implemented several policy changes in recent years. The drug formulary required by Assembly Bill (AB) 1124 became effective in January 2018. Two fraud-fighting measures, AB 1244 and Senate Bill (SB) 1160, were enacted in January 2017. Finally, SB 863, a comprehensive piece of reform legislation, went into effect in January 2013. 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 (ASC) services, and nonhospital professional services. These regulatory changes are also potential factors influencing the results discussed in this report.

CompScope™ Medical Benchmarks for California, 24th Edition. William Monnin-Browder. October 2023. WC-23-34.

Copyright: WCRI

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Research Questions:

  1. How are workers' compensation medical payments distributed across providers and services?
  2. How do medical payments per claim, prices, and utilization differ across study states?
  3. How have medical payments per claim, prices, and utilization changed over time within California, and what are the major drivers of those changes?

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