Waltham, MA, May 5, 2026—A new report from the Workers Compensation Research Institute (WCRI) gives policymakers an understanding of how hospital outpatient payments for common knee and shoulder surgeries compare across states and how payment rules shape costs.

“With many states reexamining hospital fee regulations, this study provides meaningful state comparisons and shows how different regulatory approaches influence payment growth and payment levels,” said Sebastian Negrusa, vice president of research at WCRI.

The report, Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 2026 Edition, benchmarks hospital outpatient payments related to surgeries in 36 states, covering 88 percent of U.S. workers’ compensation benefits. It also compares workers’ compensation payments with Medicare rates and examines the impact of major fee regulation changes from 2005 to 2024.

Key findings include:

  • Faster payment growth in states without fixed-amount fee schedules: From 2011 to 2024, hospital outpatient surgery payments rose by roughly twice as much in charge‑based states and states without fee schedules, compared with the typical fixed‑amount fee schedule state.
  • Higher payments in non‑fee‑schedule states: Payments were substantially higher—often more than double—than in fixed‑amount states.
  • Wide variation across states relative to Medicare: Payments ranged from 35 percent ($2,711) below Medicare in Nevada to 471 percent ($28,713) above Medicare in Alabama.

The study, authored by Drs. Olesya Fomenko and Rebecca Yang, is free for members and available to nonmembers for a fee. Click here for more information or to download the full report.

ABOUT WCRI

The Workers Compensation Research Institute (WCRI), based in Waltham, MA, is an independent, not‑for‑profit research organization founded in 1983. WCRI provides objective information through studies and data collection that follow recognized scientific methods and rigorous peer review. The Institute does not make recommendations or take positions on the issues it researches, ensuring neutrality and credibility. Funding for WCRI’s research comes from its diverse membership, which includes employers, insurers, government agencies, managed care companies, health care providers, regulators, labor organizations, and state, federal, and international agencies.