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Interstate Comparison: Medical Claim Costs and Utilization by Provider Type, 2007/2008 Claims with More Than 7 Days of Lost Time, Adjusted for Injury and Industry Mix (12 months' average maturity)

Measure	CA^a	FL	IA	IL	IN	LA	MA	MD	MI	MN	NC	PA	TN	TX	WI	15-State Median^b
Physician
Percentage of medical payments	49%	34%	37%	41%	35%	32%	36%	32%	34%	35%	28%	29%	42%	37%	41%	35%
Percentage of all claims	98%	98%	95%	95%	97%	97%	91%	96%	97%	96%	97%	97%	99%	97%	95%	97%
Average medical payment per claim	$3,599	$3,459	$4,332	$6,191	$4,491	$3,554	$2,070	$2,355	$2,671	$3,410	$3,233	$3,018	$4,339	$2,973	$5,457	$3,459
Index of per claim utilization	112	112	93	114	99	100	75	94	100	87	103	112	112	105	88	100
Average number of visits per claim	13.3	10.6	9.0	12.4	9.6	10.0	7.8	10.2	10.4	9.5	10.4	11.9	10.4	11.0	9.2	10.4
Average number of services per visit^c	2.9	2.5	2.3	2.9	2.5	2.5	2.1	2.5	2.7	2.6	2.5	2.7	2.5	2.5	2.2	2.5
Index of average prices	98	100	137	174	145	109	99	86	97	126	95	96	123	91	215	100
Average payment per visit	$270	$327	$483	$499	$470	$357	$264	$230	$257	$359	$312	$254	$416	$270	$596	$327
Chiropractor
Percentage of medical payments	2%	0%	0%	2%	0%	0%	1%	2%	0%	2%	0%	2%	0%	5%	1%	1%
Percentage of all claims	11%	3%	6%	8%	2%	3%	7%	9%	3%	13%	2%	8%	2%	16%	10%	7%
Average medical payment per claim	$1,091	$965	$805	$2,810	$733	$1,372	$1,052	$1,327	$1,082	$1,673	$918	$2,421	$658	$2,586	$1,422	$1,091
Index of per claim utilization	88	102	71	168	52	n/a^d	116	130	97	140	85	206	72	233	94	100
Average number of visits per claim	10.6	10.8	9.2	17.9	7.2	12.2	16.8	16.1	12.5	17.4	11.7	21.5	7.4	16.0	14.9	12.5
Average number of services per visit^c	3.1	3.6	2.7	3.8	2.4	n/a^e	2.7	3.3	2.7	3.3	3.3	3.8	3.2	4.3	2.5	3.2
Index of average prices^f	98	88	86	142	108	115	73	90	104	100	86	103	87	102	126	100
Average payment per visit	$103	$90	$88	$157	$101	$113	$63	$82	$87	$96	$78	$113	$89	$162	$96	$96
PT/OT
Percentage of medical payments	8%	11%	7%	11%	9%	11%	8%	12%	10%	5%	7%	12%	9%	11%	6%	9%
Percentage of all claims	56%	58%	39%	43%	46%	47%	33%	42%	35%	31%	45%	46%	50%	52%	28%	45%
Average medical payment per claim	$976	$1,864	$1,908	$3,835	$2,410	$2,464	$1,238	$2,068	$2,133	$1,531	$1,644	$2,628	$1,760	$1,603	$2,666	$1,908
Index of per claim utilization	60	122	92	145	97	n/a^d	100	135	115	71	114	153	108	94	87	100
Average number of visits per claim	11.5	16.0	15.3	18.7	14.2	18.0	14.8	17.7	16.3	12.1	15.3	19.6	14.5	12.0	13.9	15.3
Average number of services per visit^c	3.3	4.0	3.2	4.3	3.7	n/a^e	3.8	4.3	3.9	3.5	4.0	4.2	3.9	3.9	3.4	3.9
Index of average prices^f	92	82	116	147	133	114	70	88	108	115	78	100	93	97	166	100
Average payment per visit	$85	$116	$125	$205	$170	$137	$84	$117	$131	$127	$107	$134	$122	$133	$192	$127
Hospital outpatient provider^g
Percentage of medical payments^h	10%	20%	32%	25%	30%	31%	29%	18%	32%	30%	33%	27%	15%	20%	34%	29%
Percentage of all claims^h	45%	52%	77%	68%	70%	65%	79%	55%	70%	66%	65%	76%	66%	50%	73%	66%
Average medical payment per claim^h	$1,635	$3,848	$4,661	$5,288	$5,278	$5,048	$2,038	$2,204	$3,537	$4,386	$5,883	$3,060	$2,383	$2,986	$5,829	$3,848
Average number of services per claimⁱ	8.2	15.5	24.8	20.5	22.1	18.0	21.8	9.6	25.8	21.1	20.6	34.1	13.5	16.6	24.7	21
Average number of visits per claim^h	3.1	3.6	8.7	6.0	6.3	4.3	7.5	3.2	7.5	6.7	5.4	8.4	4.4	4.4	8.1	6.0
Average number of services per visit^h	2.6	4.3	2.9	3.4	3.5	4.2	2.9	3.0	3.5	3.2	3.8	4.1	3.1	3.7	3.0	3.4
Average payment per serviceⁱ	$200	$248	$188	$258	$239	$280	$93	$229	$137	$208	$286	$90	$177	$180	$236	$208
Average payment per visit^h	$2,091	$1,313	$2,371	$4,006	$2,753	$4,322	$918	$1,096	$1,548	$2,909	$2,944	$800	$2,364	$1,569	$2,557	$2,364
Other medical provider^j
Percentage of medical payments	11%	10%	4%	4%	4%	7%	5%	6%	5%	4%	7%	6%	6%	9%	4%	6%
Percentage of all claims	57%	73%	56%	46%	57%	59%	45%	50%	54%	53%	67%	61%	63%	75%	47%	57%
Average medical payment per claim	$1,339	$1,456	$820	$1,116	$821	$1,299	$582	$783	$704	$709	$1,109	$944	$1,038	$963	$948	$948
Index of per claim utilization	109	183	97	125	100	131	93	97	98	86	104	118	91	220	85	100
Average number of visits per claim	6.2	7.6	4.5	5.1	5.1	7.3	4.7	5.3	4.2	4.2	6.5	5.6	5.5	5.6	4.1	5.3
Average number of services per visit	2.0	2.0	1.7	1.8	1.6	1.8	1.5	1.6	1.7	1.6	1.6	1.7	1.8	2.0	1.7	1.7
Index of average prices	99	117	74	174	129	111	77	92	93	130	94	100	110	100	186	100
Average payment per visit	$216	$192	$182	$221	$162	$178	$124	$148	$166	$168	$172	$169	$187	$172	$229	$172
Notes: Claims with 12 months' average maturity. 2007/2008 refers to claims arising in October 2006 through September 2007, evaluated as of March 2008.
^a For California, the number of services per visit for providers of physical medicine may be somewhat understated and prices somewhat overstated relative to other states because some physical medicine services are billed in 30-minute increments rather than the standard 15 minutes.
^b The 15-state median is the state ranked 8th on a given measure; that state changes depending on the measure being evaluated.
^c This includes billing for hot and/or cold packs (97010) which are not necessarily reimbursed in all states.
^d Because not all services billed by Louisiana physical/occupational therapists and chiropractors are comparable to those in other states and they are defined too broadly to be crosswalked with codes used in other states, we are unable to compare the utilization index for these providers.
^e Because not all services billed by Louisiana physical/occupational therapists and chiropractors are comparable to those in other states and they are defined too broadly to be crosswalked, we are unable to compare the number of services per visit for these services and providers. As noted, the price index relies on services for which crosswalks can be accomplished.
^f Physical medicine codes in Louisiana are billed using state-specific PT/OT codes. While many of these codes can be directly mapped to standard physical therapy services, some cannot. Specifically, those codes for therapeutic exercises and activities cannot be directly mapped. We only include those codes that can be directly mapped in the price analysis. In Louisiana, this means that the percentage of physical medicine payments that are included in the price analysis is less than the 74 to 98 percent found in other states. In Louisiana, the price analysis of the physical medicine category (and the services provided by physical/occupational therapists and chiropractors) is based on 53 percent of the services (mostly modalities as opposed to therapeutic activities and exercises).
^g For the most part, hospital inpatient or outpatient services do not include payments to stand-alone ambulatory surgical centers, which are not consistently defined in the data but are most often included in the nonhospital physician category.
^h More claims receive hospital treatment in Massachusetts and Pennsylvania than in other states. This may mean that more claimants are seen in hospital settings or that more hospital billing is done even when the setting is a physician’s office. The result is that there are more services in the hospital provider category in Massachusetts and Pennsylvania. Overall, injuries treated by hospital providers in Massachusetts and Pennsylvania may be less severe than those treated in other states; therefore, costs and utilization may not be comparable to other states.
ⁱ For hospital outpatient services, because the revenue codes often used in hospital billing are too broadly defined to support a robust marketbasket of services and an estimate of the relative intensity of services, we report average payment per service and number of services per claim.
^j Other nonhospital providers include physicians' assistants, nurses, counselors, medical equipment suppliers, etc.
Measures:
• Percentage of medical payments: The sum of payments to each provider type or for each service group, divided by the sum of total medical payments.
• Percentage of all claims: The proportion of all claims with medical bill data with at least one service rendered by the provider type.
• Average medical payment per claim: The sum of medical payments to each provider type, divided by the number of claims involving the provider type.
• Index of per claim utilization: Measures the relative utilization compared to other states. The median state = 100. An index of 120 means that the state's utilization is 20 percent higher compared to the median state and an index of 80 means that the state's utilization is 20 percent lower compared to the median state. The utilization measures the volume of services provided as well as the relative resource intensity of the services provided per claim.
• Average number of visits per claim: The total number of visits to each provider type, divided by the number of claims involving the provider type or service group.
• Average number of services per visit: The total number of services paid to each provider type, divided by the total number of visits involving the provider type or service group.
• Index of average prices: The index measures average unit prices paid relative to the median state. The median state = 100. If a state's index is 80, this means that prices are on average 20 percent lower than the median state; if a state's index is 120 this means that the prices are on average 20 percent higher than the median state.
• Average payment per visit: The sum of payments made for each unique date of service (visit).
Key: n/a: not available; physician: medical doctor or doctor of osteopathy; PT/OT: physical or occupational therapist. Other providers include nurses, physicians' assistants and other specific providers not included in the list above.

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