Fee Schedule Change Shifted Spending to Primary Care
California’s conversion of its fee schedule to the system used by Medicare increased the share of dollars spent on primary care while reducing the share spent on specialists, meeting a key goal of the legislation that mandated the change, according to research by the California Workers’ Compensation Institute.
The industry group said spending on all medical services declined from the time the Division of Workers’ Compensation began the transition to Medicare’s Resource-Based Relative Value Scale in 2013 to the first full year of implementation in 2018. But the 5.2 percent decline in claim volume and 20.4 percent decline in aggregate payments was not spread among medical providers equally.
CWCI said spending on physical medicine services declined 17.2 percent during that period, while spending on pathology and laboratory services dropped 71.8 percent. The decline in the number of unique claims in each service category also varied. Physical medicine claims dropped 4.4 percent from 2013 to 2018 while pathology and laboratory service claims dropped 42.9 percent.
“The varying reductions in the volume of services among the different categories, as well as updates to the service codes and service descriptions included in the new fee schedule, resulted in a reallocation of the fee schedule dollars, with an increased share paying for primary care, and a smaller share paying for specialty services, which was a key goal behind the adoption of the RBRVS fee schedule,” CWCI said.
Even as the number of claims declined, the amount paid to some medical providers increased. Payments for surgery serviced increased 2.1%, medicine 28.5 percent, durable medical equipment 35.9 percent, prosthetics, orthotics and supplies 39.4 percent, evaluation and management 39.4 percent and physical medicine 57.6 percent.
On the flip side, average payments fell for pathology and lab services by 15.3 percent, radiology by 17.2%; and special servicesby 35.6% percent.
The study by Senior Research Analyst Stacy Jones looked at 35.9 million medical services provide to injured workers from 2013 through 2018, CWCI said.
Cowbell Cyber and Advisen Form Data Partnership
Cowbell Cyber, a cyber insurance carrier that launched in January, announced that it has formed a partnership with Advisen to incorporate data on cyber loss events into its underwriting platform.
Cowbell, based in Pleasanton, Calif., uses the data to compile its Cowbell Factors, which is a risk measurement that Cowbell uses to set premium rates and address cyber coverage gaps.
“As damages inflicted by cyberattacks increase, coverage must be aligned precisely to a company’s cyber risk to effectively mitigate losses and stem the after-effects of an incident,” stated Jack Kudale, founder and chief executive officer of Cowbell Cyber.
He said Advisen’s loss events dataset will yields a more effective early warning system and accurate underwriting.
Cowbell Cyber says it uses “an inside-out approach” to offer dynamic cyber risk assessments that provide customers with immediate insights into insurable risks. Advisen, based in New York City, provides data and communication services to insurance carriers.
Chubb Makes Incident Alert to Excess Casualty
Chubb announced that its signature Incident Alert tool is now available for excess sasualty clients.
The tool, which has previously been used by Chubb environmental and cyber customers, now can assist excess casualty clients during a catastrophic event to help identify qualified response contractors, manage cleanup efforts and mitigate potential liabilities.
Chubb said its clients can now report an incident using their smartphone, tablet or computer, and expedite incident reporting. Once an incident is reported, clients are assigned an incident response manager to help quickly align and deploy appropriate resources.
Chubb is an international property and casualty carrier. Its U.S. operations are headquartered in Philadelphia.
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