IN MANY STATES, HOSPITALS WERE PAID AT LEAST $2000 MORE
FOR COMMON SURGERIES FOR INJURED WORKERS THAN THE
CAMBRIDGE, MA, June 21, 2013
A new 16-state study from the Workers’
Compensation Research Institute (WCRI) says that
in half of the study states, hospital outpatient payments
for shoulder surgeries in workers’ compensation were at
least $2,000 (or 43 percent) higher than group health, which
is otherwise known as commercial or private insurance.
Compensation and Group Health Hospital Outpatient Payments,
is the first to compare hospital payments for the
same surgical procedure when paid for by group health versus
large differences in costs in many states. Policymakers
looking to contain medical costs in these states may want to
ask if the difference is necessary to induce hospital
outpatient departments to treat injured workers”, said
Richard Victor, WCRI’s executive director.
also found that workers’ compensation payments exceeded
group health payments by the most in states where the price
regulations were based on a percent of the hospital’s
charges or had no hospital price regulation.
compares hospital outpatient payments made by workers’
compensation and group health for treatment of common
surgical cases in 16 large states, which represent 60
percent of the workers’ compensation benefits paid in the
United States, and covers hospital outpatient services
delivered in 2008. Given that most study states,
except Illinois, North Carolina, and Texas, did not have
substantial changes in their fee schedule regulations after
2008, the interstate comparisons should provide a reasonable
approximation for current state rankings in workers’
compensation/group health payment differences.
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Compensation Research Institute (WCRI) is an independent,
not-for-profit research organization based in Cambridge, MA.
Founded in 1983, the WCRI is recognized as a leader in
providing high-quality, credible, and objective information
about public policy issues involving workers' compensation
systems. WCRI's diverse membership includes employers;
insurers; governmental entities; managed care companies;
health care providers; insurance regulators; state labor
organizations; and state administrative agencies in the
U.S., Canada, Australia, and New Zealand.