This study examines medical payments, prices, and utilization in Texas and compares them with 17 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Virginia, and Wisconsin).
The study also examines how these metrics of medical payments and care have changed following the Texas series of reforms focused on medical costs, particularly House Bill (HB) 7 in 2005. HB 7 impacted both prices and utilization of medical care as the various provisions were implemented beginning in late 2005. The data in this report likely reflect nearly all of the effects of HB 7 provisions, including certified medical networks and the required use of treatment guidelines and utilization review.
The report can help identify changes over time in the provision of workers’ compensation medical care; detect areas where medical payments per claim, prices, or utilization may be higher or lower compared with other study states for a set of similar claims; or reveal areas where legislative changes or system features and processes may be impacting the costs or delivery of medical services.
This study covers 2009 to 2014, with claims experience through March 2015. Where relevant, findings from other Workers Compensation Research Institute (WCRI) studies are added to provide a more complete picture of the system.
CompScope™ Medical Benchmarks for Texas, 17th Edition. Carol A. Telles. October 2016. WC-16-66.
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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