The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released the 2019 California Workers’ Compensation Aggregate Medical Payment Trends report comparing medical payment information from 2017 to 2019.
The report is available in the Research section of the WCIRB website.
This report analyzes medical payment and utilization trends by provider type, service locations and service types. The report also includes an analysis on utilization and cost of opioid prescriptions and physical medicine services over time and by region.
Key findings from the report include:
— Overall medical payments and payments per claim continued to decline in 2019, with pharmaceuticals experiencing continuous sharp declines in medical payments.
— Physical therapy services experienced the largest increase in the share of medical payments, largely driven by increases in the paid per service.
— Physical Medicine and Rehabilitation procedures are the fastest growing within all physician services, and use of hematological agents increased more significantly than other therapeutic groups from 2018 to 2019.
— Urban areas had a higher share of claims involving physical medicine services, while more suburban and rural areas had lower shares.
— Physician Office remained as the leading Place of Service, accounting for the highest share (55%) of medical payments in 2019. This was mostly driven by its highest share of medical transactions in 2019.
— Urgent Care Center experienced the largest percentage increase in the share of the medical paid.
— Paid per transaction increased significantly for Emergency Rooms and Outpatient Hospitals in 2019, yet their transaction shares remained similar to the 2018 level.
— The share of medical payments for Pharmaceuticals decreased significantly by about 43%, from 6% in 2017 to 3% in 2019.
— Key drivers of the decrease include legislation and policies intended to restrict inappropriate prescribing, use of CURES database to monitor prescriptions of controlled substances, anti-fraud efforts, and the Drug Formulary.
— The number of claims involving opioid prescriptions continued to decline significantly.
— Tulare/Inyo and Bakersfield had the highest share of claims involving opioid prescriptions, while the Silicon Valley area and Los Angeles Basin had the lowest share.
— The share of total medical transactions for ML104 (the most complex and expensive Medical-Legal evaluation) decreased by 11% in 2019 compared to 2017, while that for — ML105-106 (testimonies and supplementary evaluations) increased by 4%.
— The paid per transaction for ML104, ML105-106 and ML100 (missed appointment) continued to increase modestly.
The report was based on WCIRB medical transaction data with transaction dates from January 1, 2017 through December 31, 2019. The medical transaction data does not include: (a) medical payments made directly to injured workers or (b) payments made to any known third-party who may be assigned medical management.