Previous studies indicated a sharp reduction in medical payments immediately after the enactment of the reforms, followed by a trend of higher payments through the first half of 2009. The latest research shows the trend continued through June 2010.
Between 2002 and 2004, California lawmakers enacted changes "designed to assure that the type and quantity of treatment provided to injured workers was appropriate, as well as to help contain the rising cost of care," according to the study. Among the key measures were:
- Adoption of a mandatory medical treatment utilization schedule.
- A cap of 24 visits on physical medicine, chiropractic care, and occupational therapy.
- Expansion of the Official Medical Fee Schedule, including a revised pharmacy schedule and a generic drug substitution requirement.
- An extension of medical control from 30 days postinjury to the life of the claim for employers with workers' comp medical provider networks.
The study found the average amounts paid for treatment, pharmaceuticals and durable medical equipment, med-legal reports, and medical management containment took a "steep yet brief downturn" immediately after the reforms. That was followed by a distinct trend of increasing payments associated with work injuries beginning in accident year 2006 and continuing through the end of the study period.
"While the impact of the increases in average medical payments on total workers' comp medical payments has been significantly muted by the steady decline in claim frequency during the study period, should these trends continue, any increase in claim frequency could lead to a spike in overall workers' comp medical losses," the study said.
The researchers looked at data from more than half a million California workers' comp indemnity claims with dates of injury from January 2002 through March 2010.
The data were used to calculate average medical payments at three, 12, 24, 36, 48 and 60 months postinjury for claims from the nine different accident years. The research showed that the medical expense cost components, whether measured at 12 or 24 months postinjury, are all above pre-reform levels.
Read more at the WorkersComp Forum homepage.
April 28, 2011
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