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Average facility fees paid to ambulatory surgery centers (ASCs) for treatment of injured workers in California have declined 27% per episode and 29% per procedure since fee schedule changes mandated by SB 863 were adopted in 2013 according to updated data from a joint study by the California Workers’ Compensation Institute (CWCI) and the Workers’ Compensation Insurance Rating Bureau of California (WCIRB). The findings, which confirm preliminary results published last year, show cost reductions under the ASC fee schedule adopted by the state slightly exceed the WCIRB’s 2012 estimate of a 25 percent reduction in ASC costs, which was included in the January 1, 2013 Pure Premium Rate Filing.
The new study calculates and compares the average amounts paid for workers’ compensation outpatient surgery services rendered in the year preceding the adoption of the revised fee schedule (2012) and in the first 18 months after the revised fee schedule took effect (January 2013 through June 2014). Payment results were measured both on a per procedure basis using CWCI data, and a per episode basis using WCIRB data. In addition, the authors looked for changes in several other factors that can affect the total amounts paid to ASCs.
Among the key findings of the report are:
CWCI and WCIRB have jointly published the updated data, including additional details, tables and analyses in a report, “Ambulatory Surgery Center Cost Outcomes Follow-Up Study: The Impact of California Workers’ Compensation Reforms.” The study is available for free to the public and may be viewed, printed or downloaded from the Research section of the Institute’s website www.cwci.org.
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