Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 7th Edition

By Rebecca (Rui) Yang, Olesya Fomenko

June 28, 2018 Related Topics: Medical Costs, Hospital Outpatient Payment Index

Rising hospital costs in the treatment of injured workers have received attention from public policymakers and system stakeholders in many states. To assist in better understanding these costs, this study compares hospital outpatient payments across states and monitors the impact of fee schedule reforms from 2005 to 2016. The study also includes an additional benchmark comparing workers’ compensation hospital outpatient payments and Medicare rates. This helps states better understand their hospital payments since Medicare is one of the largest payors.

The analysis of these comparisons focuses on the experience of states with different types of fee regulations. The analysis captures payments for services provided and billed by hospitals, and it excludes professional services billed by nonhospital medical providers (such as physicians, physical therapists, and chiropractors) and transactions for durable medical equipment and pharmaceuticals billed by providers other than hospitals. The analysis also excludes payments made to ambulatory surgery centers.

The 35 states included in this study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, 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. The study states are geographically diverse and represent a wide range of industries and a variety of regulation choices for hospital payments under workers’ compensation.

Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 7th Edition. Olesya Fomenko and Rui Yang. June 2018. WC-18-22.

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Research Questions:

  • How do hospital outpatient payments for common surgical episodes in my state compare with other states?
  • Do hospital outpatient payments in my state grow faster or slower than in other states?
  • What is the impact of hospital outpatient fee regulations on hospital outpatient reimbursement levels and growth rates?
  • How do hospital outpatient payments in workers’ compensation compare with Medicare for the most common group of surgical procedures?

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