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Measures of number of injuries, utilization, and spending remained fairly constant through the implementation period

• The number of injuries per year remained constant through the SB 863 implementation period.
• Measures of total utilization and spending remained fairly constant within the first 12 months after injury from before to after the implementation of key SB 863 provisions.

For the most part, implementation of the new RBRVS went smoothly

• Stakeholder interviews and the technical advisory group indicated that, for the most part, implementation of the RBRVS went smoothly.
• Analyses of WCIS data focused on changes in utilization and spending that were due to RBRVS implementation. Spending increased in some specialties and decreased in others.
• However, there were significant changes in certain specific service categories. Some of these may be attributed to how certain kinds of services were billed in response to the RBRVS.

Overall, this research found no evidence that SB 863 increased expenditures

• Expenditures for certain types of settings and services declined more for injured workers than for a comparison group. Certain other inpatient expenditures increased.
• However, the number of billed claim lines decreased overall for injured workers.
• Relative value units increased, suggesting that, even though the number of claim lines may have decreased more for injured workers, the practitioner intensity per injury increased.

California Senate Bill (SB) 863 included several provisions that were intended to improve the efficient delivery of high-quality medical care to injured workers. This report evaluates several of the individual provisions, including a switch to physician and other practitioner payment based on a new resource-based relative value scale system (RBRVS), other fee schedule changes, and changes to the dispute resolution process. The authors examined data from the California Worker's Compensation Information System (WCIS) and used quasi-experimental methods to evaluate the overall impact of SB 863 provisions on medical care utilization and spending. The authors also conducted interviews with a convenience sample of medical experts, and held ongoing consultations with a technical advisory group. The report also addresses medical-legal evaluations, including the independent medical review (IMR) process, and other utilization review issues. Broadly, this research found no evidence that SB 863 increased expenditures.

• Chapter One

  Introduction

• Chapter Two

  Data

• Chapter Three

  Trends in California Workers' Compensation Volume and Payment, 2007–2015

• Chapter Four

  Resource-Based Relative Value System Fee Schedule for Physician and Other Practitioner Services

• Chapter Five

  Other Fee-Schedule Issues

• Chapter Six

  Changes in the Medical Necessity Dispute-Resolution Process

• Chapter Seven

  Overall Effects on Health Care Spending and Utilization

• Chapter Eight

  Summary and Recommendations

• Appendix A

  Comparing Injured Workers With and Without JCNs

• Appendix B

  Supplemental Information for Chapter 5

• Appendix C

  Supplemental Information for Chapter 6

• Appendix D

  Chapter 7 Supplemental Tables