Research Catalog
- Title
- Medical care provided under California's workers' compensation program : effects of the reforms and additional opportunities to improve the quality and efficiency of care / Barbara O. Wynn, Justin William Timbie, Melony E. Sorbero.
- Author
- Wynn, Barbara O.
- Publication
- Santa Barbara, Calif. : RAND, Center for Health and Safety in the Workplace, 2011.
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| Status | Format | Access | Call Number | Item Location |
|---|---|---|---|---|
| Text | Request in advance | HD7103.65.U62 C289 2011 | Off-site |
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Details
- Additional Authors
- Description
- xxvii, 93 p. : col. ill.; 28 cm.
- Summary
- Since 2004, significant changes have been made to the California workers⁰́₉ compensation (WC) system. The Commission on Health and Safety and Workers⁰́₉ Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This monograph synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system.
- To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost-containment expenses be reported by category of cost; compile information on the types of medical services that are subject to UR denials and expedited hearings; and expand ongoing monitoring of system performance. Finally, to increase administrative efficiency, California should use an external medical review organization to review medical-necessity determinations, and it should explore best practices of other WC programs and health programs in carrying out medical cost-containment activities.
- To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations.
- To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers⁰́₉ Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available.
- Series Statement
- Rand Corporation monograph series
- Uniform Title
- Rand Corporation monograph series
- Subject
- Note
- "Prepared for the Commission on Health and Safety and Workers' Compensation."
- "Center for Health and Safety in the Workplace"
- "A study by the Rand Institute for Civil Justice and Rand Health."
- "MG-1144-CHSWC"--P. [4] of cover.
- Bibliography (note)
- Includes bibliographical references (p. 87-93).
- Processing Action (note)
- committed to retain
- Contents
- Introduction -- An Overview of Workers' Compensation Medical Expenditures -- Payments for Medical Services Provided to Injured Workers -- Medical Provider Networks -- Medical Cost-Containment Expenses and Activities -- Monitoring System Performance -- Increasing the Value of Workers' Compensation Medical Care.
- ISBN
- 9780833058362 (pbk.)
- 0833058363 (pbk.)
- LCCN
- ^^2011935333
- OCLC
- 746835027
- Owning Institutions
- Harvard Library