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Interstate Comparison: Medical Claim Costs and Utilization by Provider Type, 2009/2010 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	NJ	PA	TX	VA	WI	16-State Median^b
Physician
Percentage of medical payments	47%	35%	33%	41%	34%	29%	39%	31%	31%	31%	27%	44%	28%	38%	32%	39%	34%
Percentage of all claims	98%	98%	96%	95%	97%	97%	92%	96%	96%	96%	98%	96%	96%	98%	98%	95%	96%
Average medical payment per claim	$3,631	$3,996	$4,580	$7,765	$5,483	$4,264	$2,668	$2,776	$2,763	$3,680	$3,823	$5,720	$3,261	$3,585	$4,649	$6,694	$3,910
Index of per claim utilization	107	109	87	121	100	103	77	100	95	78	106	81	110	100	100	91	100
Average number of visits per claim	13.2	10.5	9.2	13.6	10.7	10.5	8.2	11.1	10.3	9.5	11.2	9.5	12.1	11.5	10.6	9.8	10.6
Average number of services per visit^c	2.8	2.5	2.2	2.9	2.5	2.4	2.0	2.6	2.6	2.4	2.6	2.1	2.6	2.5	2.5	2.2	2.5
Index of average prices	79	79	133	171	143	100	100	76	88	113	83	150	87	86	116	204	100
Average payment per visit	$275	$380	$497	$571	$514	$404	$327	$250	$269	$387	$341	$603	$269	$312	$438	$684	$384
Chiropractor^d
Percentage of medical payments	2%	0%	0%	2%	0%	1%	1%	2%	0%	2%	0%	0%	2%	5%	0%	1%	1%
Percentage of all claims	12%	2%	5%	9%	2%	4%	7%	8%	3%	11%	2%	1%	8%	16%	2%	10%	6%
Average medical payment per claim	$1,210	$768	$430	$4,541	$1,064	$2,999	$994	$1,608	$1,290	$1,857	$882	$978	$2,654	$2,648	$1,250	$1,477	$1,270
Index of per claim utilization	90	74	37	208	64	n/a^e	102	139	101	138	72	73	203	198	99	89	100
Average number of visits per claim	10.9	9.0	6.7	21.5	8.8	19.3	15.8	19.0	14.5	18.0	10.6	7.4	21.7	14.1	12.1	15.4	14.3
Average number of services per visit^c	3.3	3.3	2.1	4.4	3.0	n/a^f	2.6	3.4	2.4	3.4	3.1	3.6	3.9	4.0	3.7	2.5	3.3
Index of average prices^f	97	85	90	152	102	121	72	90	100	100	82	105	100	108	88	119	100
Average payment per visit	$111	$85	$65	$211	$120	$155	$63	$85	$89	$103	$83	$133	$122	$188	$103	$96	$103
PT/OT
Percentage of medical payments	9%	8%	7%	12%	9%	10%	8%	13%	11%	6%	8%	10%	13%	10%	11%	6%	10%
Percentage of all claims	60%	57%	39%	47%	51%	51%	37%	43%	44%	38%	54%	50%	51%	50%	50%	33%	50%
Average medical payment per claim	$1,051	$1,664	$2,305	$4,720	$2,773	$2,792	$1,378	$2,477	$2,217	$1,756	$1,925	$2,517	$2,925	$1,909	$3,089	$3,002	$2,391
Index of per claim utilization	58	103	86	142	93	n/a^d	94	136	107	70	115	130	153	87	136	84	100
Average number of visits per claim	12.2	16.5	16.1	20.0	14.5	19.0	15.8	19.6	16.0	13.1	17.2	20.0	21.2	12.5	19.2	14.6	16.3
Average number of services per visit^c	3.4	3.7	3.2	4.2	3.8	n/a^e	3.5	4.4	3.9	3.5	3.9	4.0	4.3	3.8	4.4	3.5	3.8
Index of average prices^g	81	72	116	150	134	107	68	83	100	112	73	92	91	100	102	165	100
Average payment per visit	$86	$101	$144	$236	$191	$147	$87	$127	$139	$134	$112	$126	$138	$153	$161	$206	$139
Hospital outpatient provider^h
Percentage of medical paymentsⁱ	11%	20%	35%	25%	31%	30%	27%	15%	32%	30%	31%	17%	24%	19%	31%	32%	29%
Percentage of all claimsⁱ	45%	50%	78%	69%	71%	68%	81%	55%	70%	65%	62%	57%	76%	52%	71%	72%	68%
Average medical payment per claimⁱ	$1,845	$4,653	$5,961	$6,619	$6,938	$6,362	$2,229	$2,395	$3,982	$5,332	$6,698	$3,820	$3,491	$3,418	$6,121	$7,284	$4,992
Average number of services per claim^j	8.5	14.8	25.7	21.7	23.5	20.3	22.0	11.0	27.6	21.6	19.7	21.5	35.3	15.2	20.1	28.3	22
Average number of visits per claimⁱ	3.2	3.4	9.2	6.3	6.5	5.0	8.0	3.4	8.1	6.8	4.9	5.0	8.6	4.6	5.6	9.3	6.0
Average number of services per visitⁱ	2.6	4.3	2.8	3.4	3.6	4.1	2.7	3.2	3.4	3.2	4.0	4.4	4.1	3.3	3.6	3.1	3.4
Average payment per service^j	$217	$315	$232	$305	$295	$313	$101	$217	$144	$247	$340	$190	$99	$224	$305	$257	$240
Average payment per visitⁱ	$574	$1,366	$648	$1,044	$1,068	$1,273	$277	$694	$494	$780	$1,359	$757	$408	$737	$1,084	$787	$768
Other medical provider^k
Percentage of medical payments	9%	9%	5%	5%	6%	8%	7%	8%	8%	5%	9%	5%	7%	11%	6%	5%	7%
Percentage of all claims	60%	72%	62%	60%	69%	70%	53%	60%	66%	62%	73%	55%	65%	80%	66%	57%	64%
Average medical payment per claim	$1,154	$1,446	$1,052	$1,407	$1,278	$1,564	$773	$1,165	$984	$962	$1,440	$1,140	$1,235	$1,231	$1,360	$1,316	$1,233
Index of per claim utilization	105	109	84	98	106	108	92	98	78	91	106	100	113	203	100	90	100
Average number of visits per claim	6.6	7.4	5.6	5.9	6.2	8.5	5.4	6.2	5.9	5.2	7.6	5.6	6.4	6.9	6.7	5.2	6.2
Average number of services per visit	1.8	1.8	1.6	1.8	1.6	1.7	1.6	1.7	1.7	1.7	1.8	1.6	1.8	1.8	1.7	1.7	1.7
Index of average prices	75	77	117	133	137	109	70	90	90	122	91	104	96	86	108	179	100
Average payment per visit	$175	$195	$189	$238	$205	$184	$143	$187	$166	$186	$190	$205	$193	$178	$203	$255	$189
Notes: Claims with 12 months' average maturity. 2009/2010 refers to claims arising in October 2008 through September 2009, evaluated as of March 2010.
^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 16-state median is the average of the states ranked 8th and 9th on a given measure; those states change 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.
^dThe numbers shown for chiropractic treatment in Indiana, Louisiana, North Carolina, New Jersey, and Virginia should be used with caution because of relatively small cell sizes (less than 200) underlying the measures.
^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 with codes used in other states, we are unable to compare the utilization index for these providers.
^f 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.
^g 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 97 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 63 percent of the services (mostly modalities as opposed to therapeutic activities and exercises).
^h 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.
ⁱ 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.
^j 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.
^k 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 with the median state, and an index of 80 means that the state's utilization is 20 percent lower compared with 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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