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Updated SB 863 Cost Monitoring Report Released

The WCIRB has released its Senate Bill No. 863 WCIRB Cost Monitoring Report — 2015 Retrospective Evaluation which is part of a multi-year cost monitoring plan developed by the WCIRB following the signing of SB 863 by the California Governor on September 18, 2012.

This Report includes an updated retrospective evaluation of the cost impact of a number of SB 863 provisions based on data emerging through the third quarter of 2015. Based on the most current information, the WCIRB estimates the impact of SB 863 is an annual net savings of $770 million, or 4.1%, of total system costs.

Shown below are the principal findings of the Report:

  1. The impacts of increases to weekly permanent disability (PD) minimums and maximums for 2013 and 2014 injuries are emerging consistent with initial projections.
     
  2. Changes to PD ratings related to the elimination of the future earning capacity (FEC) and PD add-ons were projected to increase average PD ratings by approximately 6% (prior to any impact from the Ogilvie v. City and County of San Francisco decision). This is generally comparable to data on early 2013 PD ratings from the California Disability Evaluation Unit (DEU) which suggests increases in average PD ratings 3% to 8% above the pre-reform rate of growth.
     
  3. The changes to PD related to FEC were estimated to eliminate any increases to PD for the Ogilvie decision and included significant savings to frictional costs resulting from the elimination of Ogilvie. However, since the implementation of SB 863, average allocated loss adjustment expense (ALAE) costs per claim have not declined and, in fact, have increased significantly, suggesting no savings to ALAE from the elimination of Ogilvie are emerging.
     
  4. Indemnity claim frequency was projected to increase modestly from 2012 to 2014, in part due to SB 863 changes to indemnity benefits. Indemnity claim frequency for accident years 2013 and 2014 is emerging generally consistent with projections. Although indemnity claim frequency did increase significantly in 2012, it had been increasing prior to the enactment of SB 863 in the third quarter of 2012.
     
  5. The number of lien filings was projected to decrease by approximately 41% as a result of the SB 863 lien filing fee and statute of limitations. Although filings in 2013 and 2014 decreased by approximately 60% annually when compared to 2011 levels, the number of liens filed increased significantly in 2015 and are projected to be only 20% lower than 2011 levels. However, some of this increase may be a result of temporary increases in lien filings due to the transition of the statute of limitations on filing liens from three years to eighteen months for dates of service on or after July 1, 2013. As a result, at this time it is not clear whether the SB 863 lien provisions will produce saving more or less than originally projected.
     
  6. SB 863’s elimination of the duplicate payment for spinal surgical implants was estimated to save approximately $20,000 per procedure, while WCIRB Medical Data Call (MDC) data shows an over $25,000, or 28%, reduction in the average cost of these procedures since 2013.
     
  7. SB 863’s reduction in maximum ambulatory surgical center (ASC) facility fees was estimated to reduce those costs by 25%, which is consistent with the reductions observed based on WCIRB MDC data estimates comparing post-January 1, 2013 reimbursements to pre-SB 863 levels. In addition, the proportion of post-January 1, 2013 services performed in outpatient hospitals compared to ASCs is consistent with pre-reform levels, suggesting no cost-shifting to outpatient hospitals is occurring.
     
  8. The frequency of independent medical review (IMR) requests through the third quarter of 2015 is far above the levels initially projected. As a result, fees paid for IMRs are expected to increase ALAE costs by approximately 2.4%, as compared to a 1% increase prospectively estimated in 2012.
     
  9. Expedited hearings related to medical treatment disputes were expected to be substantially eliminated by the new IMR process, while approximately 5,500 more expedited hearings have been held per year since the implementation of SB 863.
     
  10. While average unallocated loss adjustment expenses declined from 2012 to 2014, medical-legal costs, utilization review costs, and litigation costs have continued to emerge at pre-reform levels and average ALAE costs increased significantly through 2014, suggesting the prospectively estimated significant savings to frictional costs from IMR or other SB 863 provisions are not materializing.
     
  11. Relatively few independent bill review (IBR) requests have been filed when compared to IMR filings, with information suggesting that the majority of decisions favor the provider and result in additional payments. However, as with IMR, MPNs, and other SB 863 provisions, the IBR process may be having a significant impact on recent declines in overall medical severities.
     
  12. The changes to convert the California physician fee schedule to a Resource-Based Relative Value Scale (RBRVS) basis were estimated to increase physician costs by 2.4% for services provided in 2014 and by 1.6% for services provided in 2015. Estimates of medical payments through the first six months of 2015 suggest a 4.8% decrease in physician payments per claim for the 2014 service year and a modest increase for the 2015 service year that is generally consistent with the WCIRB’s prospective estimate.
     
  13. SB 863 changes to liens, IMR, IBR, MPNs and other areas could significantly impact medical treatment levels, and overall medical claim severities declined in 2013 and 2014 with clear indications of reduced utilization levels particularly in 2014. While it is very difficult to attribute changes in medical treatment levels to specific components of SB 863, the WCIRB estimates the SB 863 changes have resulted in an overall 5% decline in medical treatment costs.

The Senate Bill No. 863 WCIRB Cost Monitoring Report — 2015 Retrospective Evaluation is available in the Research section of the website or by clicking the link below.

WCIRB Research Forum

The WCIRB will conduct a live WCIRB Research Forum webinar on November 18, 2015 at 10:00 AM PT to discuss this Report and answer questions. The presenters of the webinar include Dave Bellusci, Executive Vice President and Chief Actuary, Gregory Johnson, Ph.D., Director, Medical Analytics and Tony Milano, Vice President and Actuary.

Date: November 18, 2015

Time: 10:00 AM – 11:00 AM Pacific Time

Register: https://attendee.gotowebinar.com/register/7217959955271465218

For those unable to attend the live webinar, a recording will be posted in the Research section of the WCIRB website following the event.

November 16, 2015