Cambridge, MA, October 12, 2021 – A new set of studies released by the Workers Compensation Research Institute (WCRI) examines the factors behind trends in medical payments per claim in state workers’ compensation systems and the impact of legislative and regulatory changes on those costs.
The studies, CompScope™ Medical Benchmarks, 22nd Edition, examine trends in payments, prices, and utilization of medical care for workers with injuries. They provide analyses of recent cost drivers and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time and from state to state.
“The reports are useful to identify where medical cost and care patterns may be changing and help identify where medical payments per claim or utilization may differ from other states,” said Ramona Tanabe, executive vice president and counsel for WCRI. “While the full impact of COVID-19 on state workers’ compensation systems is currently unclear, these studies will be a useful baseline to monitor the effects.”
The following are sample findings for some of the study states:
- California: Since 2013, prescription payments per claim with prescriptions have decreased rapidly, which may reflect several factors, including the impact of the independent medical review process, changes to the pharmacy fee schedule, the drug formulary, the application of treatment guidelines, and the practice of disallowing physician dispensing in some medical provider networks.
- Indiana: Medical payments were higher than in the typical state. Prices paid for professional nonhospital services and for facility services to ambulatory surgery centers (ASCs) were among the highest of the 36 states that WCRI monitors. These prices contributed to the higher-than-typical payments.
- Minnesota: Medical payments per claim changed less than 1.5 percent annually from 2014 to 2019 at all claim maturities. Payments per claim to ASCs decreased and hospital outpatient payments per claim remained stable in 2019, likely reflecting the impact of the 2018 fee schedule changes.
- North Carolina: After the fee schedule changes in 2015, there were decreases in payments for hospital outpatient and inpatient care, but in the most recent two years, payments increased, suggesting the fee schedule savings have been largely realized.
- Texas: Medical payments per claim were lower than the typical state and have been mostly stable since 2014, though payments per claim increased from 2017 to 2019 after three years of decreases. The 2017–2019 increases were driven mainly by double-digit growth in hospital payments per inpatient episode.
- Wisconsin: Medical payments per claim were among the highest of the states studied, driven mainly by prices paid for professional (nonhospital) services. Payments to hospitals for common outpatient surgical episodes were also among the highest of the states studied.
The studies cover the period from 2014 through 2019, with claims experience through March 2020. The 18 states in the study ― Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin ― represent more than 60 percent of the nation’s workers’ compensation benefit payments. Individual reports are available for every state except Arkansas, Iowa, and Tennessee.
For more information on these studies, visit www.wcrinet.org.
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 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.