CompScope Medical Benchmarks for North Carolina, 18th Edition

By Carol A. Telles

October 19, 2017 Related Topics: Medical Costs, Utilization, Annual State Medical CompScope™ Benchmarks

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

Policy changes in recent years have targeted a key cost driver of workers’ compensation claims in North Carolina—hospital costs. Interim fee schedule changes went into effect in 2013, with the goal of reducing payments for hospital care while increasing prices paid for office visits and physical medicine services. New fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare, as required under House Bill (HB 92), which was passed in July 2013. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect in April 2015, while changes in reimbursement for nonhospital (professional) services became effective in July 2015.

Those changes are partly reflected in the medical data we report, with up to 12 months of experience under the hospital and ASC fee schedules and up to 9 months of experience following implementation of the nonhospital fee schedule. Thus, this study provides an early look at the effects of the 2015 changes in reimbursement for medical care.

CompScope™ Medical Benchmarks for North Carolina, 18th Edition. Carol A. Telles. October 2017. WC-17-45.

Copyright: WCRI

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Research Questions:

  • How are workers' compensation medical payments distributed across providers and services? 
  • How do medical payments, prices, and utilization per claim differ across states for similar injures and workers? 
  • How have medical payments, prices, and utilization per claim changed over time within a state, and what are the major drivers of those changes?

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