In this study, we examine medical payments, prices, and utilization in North Carolina and compare them with 16 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Texas, Virginia, and Wisconsin). This study also examines how these metrics of medical costs and care have changed mainly from 2008 to 2013 for claims at 12 months of experience. We analyze claims with experience through 2014 for injuries up to and including 2013. In some cases, we use a longer time frame to supply historical context for key metrics.
Policy changes in recent years have targeted a key cost driver of workers’ compensation claims in North Carolina—hospital costs. The results we report in this 16th edition of annual studies that benchmark medical payments per claim in North Carolina fully reflect the 2009 reduction in the hospital fee schedule on hospital payments for outpatient care. Additional interim fee schedule changes became effective in 2013, partly reflected in the most recent data we report. Future editions of this study will monitor the effects of the new fee schedule rules, which base reimbursement on a percentage of Medicare.
CompScope™ Medical Benchmarks for North Carolina, 16th Edition. Carol A. Telles. October 2015. WC-15-41.
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