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CompScope Medical Benchmarks, 14th Edition  

Escalating workers’ compensation medical expenses are capturing the attention of policymakers and stakeholders, but what is behind the numbers in various states?  Higher prices? Increased utilization? 

This annual report examines sixteen large states, providing detailed measures of medical prices, payments and utilization by provider type and service group.  

Key questions addressed in this report include:

  • 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?

Fourteen of the 16 states in the 14th edition have individual state reports. To read the abstract, executive summary, or to order a report, click on the state title below.

California

Minnesota

Florida

New Jersey

Illinois

North Carolina

Indiana

Pennsylvania

Louisiana

Texas

Massachusetts

Virginia

Michigan

Wisconsin

The Effect of Reducing the Illinois Fee Schedule

In September 2011, Illinois enacted new legislation that introduced a 30 percent decrease in the fee schedule rates across all types of medical services. Important questions asked by policymakers and others after this fee schedule change are: Did a 30 percent reduction in the fee schedule produce a 30 percent change in the average medical cost of a claim? Was the 30 percent reduction too much or too little? How do the post-reform prices paid in Illinois compare with prices in other states? These important policy questions are addressed in this report.
read the abstract
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Monitoring Changes in New York after the 2007 Reforms

Questions frequently asked by policymakers and others after changes in regulations are: Which objectives are being met? Which are not being met? Are there any unintended consequences occurring from these changes?  

Key components of the regulatory changes in the New York workers’ compensation system were: an increase in maximum weekly benefit, limits on permanent partial disability duration, development and adoption of a pharmacy fee schedule, creation and implementation of medical treatment guidelines, creation of networks for diagnostic services and thresholds for preauthorization, and administrative changes to increase speed of case resolution.  

By monitoring key metrics of the performance of the New York system after the 2007 reforms, this report, the sixth in an on-going series, is an important tool to track the effectiveness of the policy changes.
read the abstract
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CompScope Benchmarks, 14th Edition 

Looking to monitor the effectiveness of legislative and regulatory changes in a state’s workers’ compensation system, measure the growth in costs of medical care, and identify important trends that may be emerging? With WCRI benchmarks, policymakers and others have the tools to answer these and other questions and to focus on the drivers of system performance.  

This comprehensive reference source, updated annually, compares the performance of 16 state workers’ compensation systems and tracks how a state’s system performance may be changing over time.  

The states in the 14th edition of CompScope™— Arkansas, California, Florida, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin—represent nearly 60 percent of the nation’s workers’ compensation benefit payments. All states except Arkansas and Iowa have an individual state report.
read the abstract
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The Prevalence and Costs of Physician-Dispensed Drugs

Policymakers and stakeholders across the country are debating whether doctors should be paid significantly more than pharmacies for dispensing the same drug. This reference book describes the prevalence, prices, and costs of physician-dispensed drugs in 24 states, which represented 70 percent of the total workers’ compensation benefits paid in the United States. It also compares prices paid for physician- and pharmacy-dispensed prescriptions for the same drugs and tracks changes in prices for drugs commonly dispensed by physicians to injured workers, allowing policymakers to see how their state compares with other states as well as what actions other states have taken to address this issue.
read the abstract
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Physician Dispensing in the Maryland Workers’ Compensation System

Examining the prevalence and costs of physician dispensing on the Maryland workers’ compensation system, the study found that the average prices paid to physician-dispensers in Maryland were often more than double the prices paid for the same drugs dispensed at a pharmacy. Further, prices paid to physician-dispensers for many common drugs increased over the study period, while prices paid to pharmacies for the same drugs typically decreased over the same period. For example, the average price paid for physician-dispensed Flexeril®, a common muscle relaxant, increased by 16 percent in three years. Over the same period, the average price paid for the same drug dispensed at pharmacies decreased by 15 percent.
read the abstract
order this report

Physician Dispensing in the Pennsylvania Workers’ Compensation System

In 2011, physicians dispensed 23 percent of workers’ compensation prescriptions and were paid 38 percent of what was spent for all prescriptions for injured workers, an increase from 17 percent of all prescriptions and 18 percent of total prescription costs from three years earlier. This study examined the rapid growth of physician dispensing in Pennsylvania, a practice that often results in much higher prices paid for a drug than if that same drug were dispensed at a retail pharmacy. The study also found frequent dispensing of some drugs with over-the-counter strength at prices much higher than if that same drug were purchased at a retail pharmacy.
read the abstract
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Impact of Banning Physician Dispensing of Opioids in Florida 

Florida House Bill 7095 banned physician dispensing of stronger opioids effective July 1, 2011. Examining changes in opioid use among newly injured workers after the implementation of the bill, the study found that the average Florida physician-dispenser continued to dispense pain medications after the ban, but increased the use of less addictive pain medications like ibuprofen and Tramadol. The study reports no material change in the percent of patients who received stronger opioids from pharmacies.
read the abstract
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Impact of Reform on Physician Dispensing and Prescription Prices in Georgia   

New regulations in Georgia, effective April 2011, changed the reimbursement rules for physician-dispensed prescriptions. The results of this study, using pre-and post-reform data, showed that the new regulations reduced prices paid for physician-dispensed drugs by 22-36 percent, achieving its objective of lowering prices for these drugs. The study also showed that the new regulations did not discourage many physicians from continuing to dispense these drugs at lower prices.
read the abstract
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A New Benchmark for Workers’ Compensation Fee Schedules:

Prices Paid by Commercial Insurers?

Nonhospital prices paid for common surgeries performed on injured workers were higher than the prices paid by group health insurers for the same surgery in almost all of the 22 states in the study. In a number of states, the workers’ compensation prices paid for common surgeries were 2–4 times higher than the prices paid by group health insurers in the state. In contrast, the prices paid for office visits under workers’ compensation were typically within 30 percent of the prices paid by group health insurers.

This study focuses on the prices actually paid for professional services billed under a specific Current Procedural Terminology (CPT) code for five common surgeries and four common established patient office visits for services delivered in 2009. The study also discusses how to generalize these results to later years.
read the abstract
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Comparing Workers’ Compensation and Group Health Hospital Outpatient Payments

A new 16-state study comparing payments for treatment of common surgical cases reported 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.     

The study, the first to compare hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation, 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. 
read the abstract
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Are you new to WCRI and the research we do?  Looking to learn more about us? 

 

FREE STUDY

 

Our Medical Price Index, Fifth Edition, published in June 2013 is available free as a PDF. Click on the links below for a no charge look at the work we do and the value of the findings we present.

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download the free PDF for this report

 

 

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Would you like to be notified when a new study is published, a web briefing is being offered, a public briefing is scheduled, or new information on our conference is available? Join WCRI's e-mail list and you will receive monthly e-mail updates about upcoming events and publications.  Click on the link below to be added to the WCRI e-mail list.

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In the News


WCRI's recent media releases

Articles referencing WCRI research.

Citybizlist, Baltimore

Physicians Put High Mark-Up On Workers Comp Pain-Killers

Patients obtaining the pain-killer Vicodin directly from a doctor in Maryland will pay nearly three times more than if they purchased it directly from a pharmacy, according to a new study.
full article

LaCrosseTribune.com

Legislators Consider Workers' Comp Changes

Wisconsin surgeons performing the same arthroscopic knee surgery on two groups of patients in recent years collected on average $1,573 from one group and $3,728 from the other.
full article

Drug Topics

Prescriptions 300% higher at some doctors' offices

Filling a prescription at a doctor’s office may be convenient, but it’s certainly no bargain for patients or taxpayers, according to an analysis of workers’ compensation payouts in Maryland and Pennsylvania.
full article

Business Insurance

Workers comp-related medical payments higher than others: WCRI

Medical payments made in relation to workers compensation-related treatments are typically higher than group health medical payments in a majority of states, according to a study released Friday by the Workers Compensation Research Institute.
full article


WCRI 2014 Annual Report/Research Review

We would like to provide you with a copy of WCRI's 2014 Annual Report & Research Review. 

We are proud of the impact our research has had in providing public officials and various system stakeholders with the information-based data they need to make better decisions. Examples of where our research has had an impact can be found starting on page 6.

We encourage you to pass this along to others in or outside your organization. Our research is funded by member organizations so enlarging our membership base allows us to expand our research agenda.  If you or a colleague are interested in becoming a member of WCRI, please let us know.

Click on the following link to download a copy of the report in PDF format. Please know it may take a minute to download.
download the free PDF for the Annual Report


WCRI Webinar Recordings Available for Purchase

Recordings of the nine WCRI webinars done in 2012 and four done in 2013 are now available for purchase on our web site. The benefit of the information from these webinars can be yours to view at your convenience.  For information on the webinar topics; and on purchasing these webinars, click below.

Hospital Outpatient Costs and the Impact of Fee Schedules

Avoiding Litigation: What Employers, Insurers and State Workers' Compensation Agencies Can Do

Compliance with Narcotics Guidelines

Comparing Virginia's Workers' Compensation System to Other States

Factors Influencing Return to Work for Injured Workers: Lessons from PA and WI

Monitoring New York's Workers' Compensation System

Physician Dispensed Drugs


Why Owners of Ambulatory Surgical Centers Do More Surgery

How Lump-Sum Settlements Influence Return to Work


Comparing Indiana's Workers' Compensation System to Other States

Opioid Problem in Workers' Compensation

Understanding Collectively Bargained Workers' Compensation Systems or "Carve-Outs"

Physician Dispensing in Maryland, Georgia, and Pennsylvania

 

   
 

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