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WCIRB Releases Aggregate Medical Payment Trends - 2016 Update

The WCIRB has released the California Workers’ Compensation Aggregate Medical Payment Trends report, comparing medical payment transaction data from calendar year 2014 to calendar year 2016. WCIRB researchers used reported medical payment data representing more than 90% of the California workers’ compensation insurance market.

Among the key findings of the report are:

  • Medical payments per claim dropped 9% from Calendar Year 2014 to $3,474.
  • The decline in medical payments per claim was driven by a drop in medical utilization, as reflected in a 10% reduction in paid medical transactions, which offset a 4% increase in payments per paid transaction.
  • The average pharmacy paid per transaction declined by 17% during the three-year period driven by decreases in all drug categories. 
  • The average paid per physician general provider transaction increased 12% during the three-year period.
  • The medical legal share of medical costs increased from 10% to 12% largely as a result of the number of medical legal reports per claim increasing 8% over the three-year period.

The full report is available in the Research section of the WCIRB website and from the link below:

Questions regarding the report may be directed to [email protected].

August 24, 2017