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This book examines the impact that changes to California's workers' compensation (WC) system have had on the medical care provided to injured workers, 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.
These proceedings are the product of a May 2003 colloquium on the workers' compensation medical benefit delivery system, with a focus on the access, cost, and quality issues facing the system and mechanisms to improve its quality and efficiency.
This complete guide for injured workers in California will help injured workers get medical treatment with their own doctor or find another, file claims on time, deal with claims adjusters who don’t want to pay benefits, and get a lump-sum settlement for the highest amount possible.
Over the past few years, nonoccupational health-insurance programs and group health plans have implemented initiatives to improve the quality and efficiency of care through incentive programs, typically called "pay for performance," or P4P. In addition, Medicare program administrators are evaluating how P4P incentives might be incorporated into Medicare payment systems. A workers' compensation (WC) P4P program could be an effective strategy to improve the quality and efficiency of care, increase patient satisfaction, and improve work-related outcomes provided it is integrated with other initiatives to improve the WC medical treatment system. The program could reward only high-performing physicians or reward improvement from any physician, and payer and provider participation could be voluntary or mandatory. Challenges to implementation include lack of clinical measures for WC conditions, multiple payers, and multiple physicians treating few WC patients and the high level of contention among stakeholders. This paper assesses the options, challenges, and potential benefits of adopting P4P incentives for physician services in California2s WC program, offering three models of programs for consideration.
In response to rapidly increasing medical costs in the California workers' compensation program, the California Commission on Health and Safety and Workers' Compensation is recommending that the current fee schedule that determines the amount health care providers are paid be linked to Medicare fee schedules. This study examines issues arising from the differences between the two types of fee schedules, modifications that may be needed to tailor the Medicare fee schedules to California's injured workers, and the implications of automatic annual updates to the schedules.
Concerns the rising cost of medical services in Calif.'s workers' compensation system. Rising costs of medical services & products are contributing to the increasing costs of the workers' compensation system -- costs that Calif.'s employers are required to pay. Chapters: Calif.'s Workers' Compensation Medical Payment System Does Not Adequately Control the Costs of Treating Injured Workers; Proposed Changes to the Medical Payment System May Control Fees for Medical Services & Products but Do Not Ensure Lower Overall Medical Costs; More Work Is Needed to Ensure That Injured Workers Have Access to Quality Care; CA Needs to Improve the Controls Over Workers' Compensation Medical Costs; & Recommendations.