Cambridge, MA, Nov. 16, 2021 – Medical payments per claim with more than seven days of lost time in Wisconsin were among the highest of 18 states studied and changed little from 2014 to 2019, according a recent study by the Workers Compensation Research Institute (WCRI).
“Higher-than-typical prices paid for professional (nonhospital) services were the main driver of Wisconsin’s higher medical payments per claim when compared with the other study states,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Payments to hospitals for common outpatient surgical episodes were also among the highest of states studied. Wisconsin is one of the few states that does not regulate professional or hospital fees with medical fee schedules.”
The study, CompScope™ Medical Benchmarks for Wisconsin, 22nd Edition, compared Wisconsin with workers’ compensation systems in 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through 2020 for injuries up to and including 2019.
The following are among the study’s other findings:
- Prices paid for professional services grew 3 percent per year from 2014 to 2019. This increase was similar to changes in other states without medical fee schedules.
- Payments per service for hospital outpatient services grew about 5 percent per year, with charges per service growing 4 percent per year between 2014 and 2018, before increasing nearly 8 percent in 2019. A combination of factors may have influenced these results: medical inflation, recent hospital consolidations, and changes in the characteristics and severity of claims receiving inpatient/outpatient care. Outside workers’ compensation, hospital rates in Wisconsin have been increasing about 4 percent annually.
- The percentage of claims receiving hospital outpatient services increased, a departure from the typical state studied where fewer claims received services in hospital outpatient departments. Nearly 80 percent of Wisconsin claims involved hospital services.
“Results from this study include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic,” Tanabe said. “The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims.”
To learn more about this study or to purchase a copy, visit https://www.wcrinet.org/reports/compscope-medical-benchmarks-for-wisconsin-22nd-edition. The report was authored by Evelina Radeva.
The Cambridge-based WCRI is recognized as a leader in providing high-quality, objective information about public policy issues involving workers' compensation systems.
The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.