Medical Benchmarks for New Jersey,
CompScope™ 12th Edition
escalation in workers’ compensation medical costs is a major driver of
the overall increase in workers’ compensation costs. For policymakers
and stakeholders contending with this rapid growth, understanding the
flow of payments—to whom and for what services—is essential.
CompScope™ Medical Benchmarks
are indispensible for identifying where changes in treatment patterns
may be occurring, where medical payments per claim or utilization may be
atypical compared with other study states, or where, because of
underutilization of medical services, there may be concerns about
restrictions on access to care.
report examines sixteen states (California,
Wisconsin), providing detailed measures of medical prices, payments,
and utilization by provider type and service group. There are individual
state reports for all states except Indiana and Iowa.
How do medical
prices, payments, and utilization per claim differ across states for
similar injuries and workers?
How have medical
prices, payments, and utilization per claim changed over time within
each state, and what are the major drivers of those changes?
Medical payments per claim in California showed rapid growth of
about 8 percent per year from 2005 to 2009, for claims with more
than seven days of lost time. This followed a large decrease of
about 30 percent from 2002 to 2005 resulting from the comprehensive
reforms in the workers’ compensation system.
Based on 2009 claims with experience as of March 2010, Illinois had,
on average, 41 percent higher medical payments per claim than the
median of the 16 states included in this analysis.
Medical payments per claim grew 12 percent per year in Louisiana
from 2007 to 2009. This rate of growth was fastest among the study
states and faster than in the three previous years for Louisiana.
Hospital payments per claim were the main driver of the recent
growth in medical payments per claim, especially hospital payments
per inpatient episode.
Earlier WCRI studies found that the higher medical costs per claim
in pre-reform Texas were driven mainly by higher utilization of
medical services by nonhospital providers—a major focus of HB 2600
and HB 7. As a result of the reforms, along with increased payor
attention and effort on managing medical care, utilization of
services decreased significantly in Texas.
CompScope™ Medical Benchmarks, 12th Edition.
E. Belton, Evelina Radeva, Bogdan Savych, Carol A. Telles, and Rui Yang.
May 2012. WC-12-02 to 15.