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Workers' Compensation Laws as of January 1, 2016

An essential tool for researching and understanding the distinctions among workers’ compensation laws in all U.S. states and certain Canadian provinces is a key resource for policymakers and system stakeholders to identify the similarities and distinctions between workers’ compensation regulations in multiple jurisdictions in effect as of January 1, 2016.
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CompScope™ Benchmarks, 16th Edition

The factors behind changing costs in state workers’ compensation systems, including the impact of legislative and regulatory reform on those costs, are examined in this 18-state study. These comprehensive reference reports measure the performance of different state workers’ compensation systems, how they compare with each other, and how they have changed over time.

The 18 states in the study are Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin. There are individual reports for every state except Arkansas and Iowa.

To read the abstract, executive summary, or to order a report, click on the state below.

California

Michigan

Florida

Minnesota

Georgia

New Jersey

Illinois

North Carolina

Indiana

Pennsylvania

Kentucky Texas
Louisiana Virginia
Massachusetts Wisconsin

Do Higher Fee Schedules Increase the Number of Workers' Compensation Cases?

Policymakers have always focused on the impact fee schedules have on access to care as well as utilization of services.  This study shines a light on an issue that policymakers and other system stakeholders might not be thinking of, which is that physicians may call an injury work-related in order to receive a higher reimbursement for care he or she provides to the patient.   

According to previously published WCRI research, in many states, workers' compensation pays higher prices than group health.  Currently,  43 states have physician fee schedules that set maximum prices for health care providers to be paid, and the established fee schedule rates vary widely across states. 
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Physician Dispensing of Higher-Priced New Drug Strengths and Formulation

This report found evidence of frequent physician dispensing of new drug strengths and a new formulation at much higher prices. This phenomenon was observed in several states with recent reforms aimed at reducing prices paid for physician-dispensed prescriptions. Frequent dispensing of higher-priced new drug products led to substantial increases in average prices paid for some common physician-dispensed drugs. This report is part of a series of WCRI studies that examine the effects of regulatory or legislative changes to the rules governing reimbursement for physician-dispensed prescriptions. 
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Texas-Like Formulary for North Carolina State Employees

In 2015, the North Carolina General Assembly directed the North Carolina Industrial Commission to study the implementation of a drug formulary for workers' compensation claims filed by state government employees. This WCRI report focuses on two major issues in that mandate—specifically, how a Texas-like closed formulary might affect the prevalence and costs of drugs prescribed to North Carolina state employees.
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Monitoring Trends in the New York Workers' Compensation System, 2005-2013

The metrics in this report provide the information necessary to observe the possible effects of some of the 2007 legislation and related administrative changes to the New York workers' compensation system.

The regular monitoring of system performance helps policymakers and system stakeholders focus attention on the objectives that are being met, objectives that are not being met, and any unintended consequences that have emerged.
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Evaluation of the 2015 Fee Schedule Rates in Illinois

This study compares the fee schedule rates and Medicare rates for a variety of medical services in Illinois as of 2015. The medical services covered in the report are professional medical services, hospital outpatient and ambulatory surgery center (ASC) facility services related to surgical procedures, and hospital inpatient services. The analysis focused on the most common services delivered to injured workers within each category.

Additionally, to provide some context on where Illinois stands with respect to other states, the study compared the fee schedules in Illinois relative to Medicare (as of 2015) with fee schedule rates relative to Medicare in other states (as of 2011) for professional medical services. The study computed the workers' compensation fee schedule rate as a percentage above or below the Medicare rate.
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WCRI Medical Price Index for Workers' Compensation, Seventh Edition (MPI-WC)

Increasing costs for medical care for treating injured workers have been a focus of public policymakers and system stakeholders. This 31-state study will help them understand how prices paid for medical professional services for injured workers in their states compare with other states and know if prices in their state are rising rapidly or relatively slowly. They can also learn if the reason for price growth in their state is part of a national phenomenon or whether the causes are unique to their state and, hence, subject to local management or reform.
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CompScope™ Medical Benchmarks, 16th Edition

The factors behind changing medical payments per claim in 17 state workers’ compensation systems and the impact of legislative and regulatory changes on those costs are examined in this edition of CompScope™ Medical Benchmarks. The studies cover the period from 2008 through 2013, with claims experience through March 2014. The 17 states in the study―Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin―represent more than 60 percent of the nation’s workers’ compensation benefit payments. There are individual reports for every state except Arkansas and Iowa.

California

Minnesota

Florida

New Jersey

Georgia

North Carolina

Illinois

Pennsylvania

Indiana

Texas
Louisiana Virginia
Massachusetts Wisconsin
Michigan  

Will The Affordable Care Act Shift Claims to Workers' Compensation Payors?

According to this study, hundreds of millions of dollars could shift from group health to workers' compensation as Accountable Care Organizations (ACO) expand under the Affordable Care Act (ACA). Although pundits have written about "cost shifting" to workers' compensation, a significant underappreciated effect of the ACA is "case-shifting" from group health to workers' compensation. The question we are addressing in this study is to what extent do the financial incentives facing providers and their health care organizations that arise out of capitation (given that workers' compensation pays fee for service) influence whether or not a case is deemed to be work-related.
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Why Surgery Rates Vary

Back pain is a critical issue in workers’ compensation, representing nearly one-fifth of the injuries. Although common, how to best treat the injury is controversial and lacks clinical consensus. Moreover, the frequency of surgery among workers with back injuries varies widely from state to state.  

This study addresses an important area of inquiry by investigating some of the hypotheses put forward to explain the wide variation in surgery rates. Some of the factors are within the control of workers’ compensation policymakers. Other factors result from the dynamics and practices of the larger health care system.
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Workers’ Compensation Medical Cost Containment: A National Inventory, 2015

As the cost of medical care for injured workers continues to grow, this study provides policymakers and system stakeholders with an inventory of the cost containment initiatives employed by 51 jurisdictions. This study updates the tables from the previous edition with the statutory provisions, administrative rules, and administrative procedures as of January 1, 2015. However, it does not provide written explanations of the initiatives in use by each state.

These initiatives aim to curb the cost of a particular service or to reduce the amount of services provided. Cost containment regulatory initiatives entail a balancing act of limiting the cost of services and inappropriate or unnecessary treatment without negatively affecting the quality of treatment or access to care for injured workers.
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Hospital Outpatient Cost Index for Workers' Compensation, 4th Edition

Rising hospital costs have been a concern and focus of recent public policy debates in many states. To assist policymakers and business decision makers in managing this growth, WCRI has created this unique study, which is updated regularly, to compare hospital outpatient costs across states, identify key cost drivers, and measure the impact of reforms.
 

The 33 states included in this study are Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.
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Predictors of Worker Outcomes

Four new state-specific studies identified new predictors of worker outcomes that can help public officials, payors, and health care providers improve the treatment and communication an injured worker receives after an injury―leading to better outcomes. The states examined were Arkansas, Connecticut, Iowa and Tennessee. The studies represent Phase 2 of a multi-phase study to examine worker outcomes.  

The studies are based on telephone interviews with 4,915 injured workers across the following 12 states: Arkansas, Connecticut, Indiana, Iowa, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Tennessee, Virginia, and Wisconsin. The surveys were conducted in 2013 and 2014 for injuries in 2010 and 2011.

To read the abstract, executive summary, or to order a report, click on the state below.

Arkansas

Iowa

Connecticut

Tennessee

 

 

 

Of Special Interest 


 

Discover WCRI


Are you new to WCRI and the research we do?  Looking to learn more about us? 

FREE STUDY

 

Our Medical Price Index, Seventh Edition, published in November 2015 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

 

 

WCRI E-Mail List


 

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.  Send an email to us at wcri@wcrinet.org telling us you want to be on our email list and we will take care of that for you.

 

 

In the News


WCRI's recent media releases

Articles referencing WCRI research.

Baltimore Sun

Md. lawmakers won't seek to limit doctors' ability to prescribe drugs

Maryland doctors who dispense under the state's workers' compensation system charge four times more than pharmacies for pills of painkillers Vicodin and Percocet and nearly seven times more for muscle-relaxer Soma, according to the Massachusetts-based Workers Compensation Research Institute.
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New York Times

New Dosages of Old Drugs Are Used to Raise Their Prices

Over the last two years, states nationwide have moved to crack down on so-called physician dispensing of prescription drugs, a practice largely limited to doctors who treat injured workers. But doctors and companies have responded by exploiting loopholes in those rules and adopting new strategies to stay one step ahead, recent studies suggest.
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The Gazette

Study: Workers cite trust issue with injuries - Fear layoff, firing after being hurt on the job

A new study has found that some workers fear they will be laid off or fired after sustaining an on-the-job injury. The study from the Workers’ Compensation Research Institute examined predictors of worker outcomes that can help Iowa public officials, insurers, and health care providers improve the treatment and communication an injured worker receives after an injury.
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CFO Magazine

New Rules on Drugs Not Curbing Workers' Comp Costs

In a trend that may perplex self-insured companies trying to rein in workers’ compensation costs, doctors who prescribe drugs from their offices are exploiting a loophole in new regulations designed to limit what they can charge for prescriptions, according to a new study.
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WCRI 2016 Annual Report/Research Review

We would like to provide you with a copy of WCRI's 2016 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

 

   
 

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