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Current State of Work Comp Health Care--How California Compares

Current State of Work Comp Health Care--How California Compares. Cost Services Price Frank Neuhauser, UC Berkeley. Average Medical Payment per Claim w/>7 Days Lost Time Is Typical (WCRI). California’s WC Fee Schedule 12% Above Medicare (on average) (WCRI). 2001 Fee Schedule. CA. MA. FL.

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Current State of Work Comp Health Care--How California Compares

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  1. Current State of Work Comp Health Care--How California Compares • Cost • Services • Price Frank Neuhauser, UC Berkeley

  2. Average Medical Payment per Claim w/>7 Days Lost Time Is Typical (WCRI)

  3. California’s WC Fee Schedule 12% Above Medicare (on average) (WCRI) 2001 Fee Schedule CA MA FL

  4. California Pharmaceutical Fee Schedule Relative to Other States California Medi-Cal Washington

  5. Average Medical Payment per Claim w/>7 Days Lost Time Is Typical (WCRI)

  6. Percent Change in Paid Medical: California vs. US Average (NASI)

  7. CA: Many More Visits per Claim Than Typical State – for Similar Claims Visits per Claim CA12-State MedianDifference Physician 11.6 7.8  49% Chiropractor 34.1 16.6  105% PT/OT 17.0 12.2  39% 1999/2000 Claims with > 7 Days Lost Time (Injury/Industry Mix Adjusted)

  8. CA Chiropractors: Most Visits per Claim

  9. Higher Medical Payment/Claim Because More Claims Have > 7 Days of Lost Time (WCRI)

  10. California Has the Highest Fraction of Lost-Time Claims Receiving PPD (RAND) 45 40 35 30 25 Percent 20 15 10 CA NM WA WI OR 5 0 Lost-time claims with PPD

  11. Comparing Systems—Work Comp Across States • Similar Cost/Indemnity claim—Initial Treatment • Many more treatments • Generally lower cost/treatment • Cost rising twice as fast as national average • More Indemnity claims • More PD claims • Claims open longer with very costly and unpredictable expenses in later years • 30% paid in first 2 years • 15% paid after 20+ years

  12. Comparing Systems –WC to Health Benefit • Health benefit pays for services only during year of contract • Different conditions • Risk sharing to control utilization and cost • Expenditures are heavily focused on the elderly and very young

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