This study examines medical payments, prices, and utilization in Florida and compares them with 17 other states (Arkansas, California, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin). How these metrics of medical costs and care have changed primarily from 2010 to 2015 is also examined. Claims with experience through March 2016 for injuries up to and including 2015 were analyzed.

Florida implemented several medical fee schedule changes after 2014. This study provides a look at how hospital payments per claim in Florida have changed using data with experience up to 15 months after the hospital fee schedule changes in 2015. This report also discussed the implications of the fee schedule change for professional services effective July 2016. The ambulatory surgery center fee schedule rates were also updated in 2016, and results discussed in this report primarily reflect experience before this fee schedule update.

In addition, the Castellanos and Westphal decisions issued by the Florida Supreme Court in 2016 are expected to affect costs and litigation expenses in the state’s workers’ compensation system. This study can help policymakers and other stakeholders in the system to identify cost drivers and emerging trends in payments, prices, and utilization of medical services among different providers prior to these court decisions.

CompScope™ Medical Benchmarks for Florida, 18th Edition. Rui Yang. October 2017. WC-17-35.