This study helps policymakers and other stakeholders identify current cost drivers and emerging trends in payments, prices, and utilization of medical services provided for treating workers with injuries in the California workers’ compensation system. It examines medical payments, prices, and utilization for various types of services by nonhospital and hospital providers in California and compares them with 17 other states. The study also examines how these metrics of medical payments and care have changed, mainly from 2013 to 2018. Claims with experience through 2019 for injuries up to and including 2018 were analyzed. In some cases, a longer time frame was used to supply historical context.

California implemented multiple policy changes in recent years. The drug formulary required by Assembly Bill (AB) 1124 became effective in January 2018, and data in this report reflect up to 15 months of experience following the implementation of that policy initiative. AB 1244 and Senate Bill (SB) 1160, two major fraud-fighting measures, were enacted in January 2017. The data in this study reflect up to 27 months of experience after the passage of these bills. SB 863, a comprehensive reform legislation, went into effect in January 2013. Results in this report reflect the state’s system performance six years after the implementation of SB 863. 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, 21st Edition. William Monnin-Browder and Rui Yang. October 2020. WC-20-27.

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