Medical Benchmarks for Virginia, CompScope™ 12th Edition

Abstracts

Medical Benchmarks for Virginia, CompScope™ 12th Edition

Rapid 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.

This report examines sixteen states (California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and 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.

Questions Addressed

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?

Sample Findings

California: 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.
Illinois: 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.
Louisiana: 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.
Texas: 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. Sharon E. Belton, Evelina Radeva, Bogdan Savych, Carol A. Telles, and Rui Yang. May 2012. WC-12-02 to 15.

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