Menu Close

The WCIRB released the California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment transaction data from the fourth quarter of 2013 to the fourth quarter of 2012. WCIRB researchers used reported medical payment data representing more than 90% of the California insurance market and accounting for approximately $1.3 billion in payments annually.

Among the findings of the report:

1) On a type of provider basis, specialist physicians, surgeons and services for hospital and ambulatory surgical centers services dropped from 53.6% of total medical paid in Q4 2012 to 49.5% in Q4 2013. During that same period, payments to general practitioners and occupational health providers increased from 13.1% to 16.2% of total paid medical.

2) On a place of service basis, payments to hospitals and ambulatory surgical centers dropped from 31.3% of total medical paid in Q4 2012 to 28.0% in Q4 2013. During that same period, office-based services increased from 47.5% of paid in Q4 2012 to 51.4% of paid in Q4 2013.

3) On a procedure basis, pharmacy spending increased from 12.8% of paid medical in Q4 2012 to 13.7% of paid medical in Q4 2013. Payments for opiates slightly declined from 3.8% of total paid medical in Q4 2012 to 3.7% in Q4 2013.

4) Pharmaceutical payments for 2013 and 2012 averaged approximately 13% of total paid medical as reflected in the WCIRB’s medical transaction data, while payments to pharmacists and pharmacies averaged about 9.7% for both years. These findings suggest that 3% to 4% of paid medical may be generated from physician dispensing in offices.

5) The fastest growing procedure between Q4 2012 and Q4 2013 was Level 4 office visits for existing patients, which is defined by the Official Medical Fee Schedule (OMFS) as involving a detailed history and examination for moderately complex medical decision-making. This code also grew the fastest between Q3 2013 and Q4 2013.

The report is available in the Research and Analysis section of the WCIRB website