This study examines medical payments per claim, prices, and utilization in Texas and compares them with 17 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, 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 and continuing mainly through 2011. 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.
Claims with experience through 2017 for injuries up to and including 2016 were analyzed. Information from other Workers Compensation Research Institute (WCRI) studies was added to provide a more complete picture of the system.
CompScope™ Medical Benchmarks for Texas, 19th Edition. Carol A. Telles. October 2018. WC-18-37.
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