This study found a puzzling trend for workers’ compensation claims in New York State. Between 2010 and 2013, the average ambulatory surgery center (ASC) payments for knee and shoulder surgeries in the state increased 22 and 65 percent, respectively. This large increase in average ASC payments was surprising given that, prior to 2015, New York fee schedule rates that determine payments for knee and shoulder arthroscopies had not changed in more than a decade. It raised the question—what factors beyond fee schedules may explain this trend?

An initial exploration of surgeries with higher payments per episode for New York claims revealed one common thread—these surgeries were performed in ASCs located across the border from New York in New Jersey, and these trends reflect the specifics of New York’s workers’ compensation fee schedule for medical services that was in effect at the time. Fee schedule changes in 2015 addressed one of the components of the fee schedule that enabled the results that we observed. This report provides further information about the phenomenon.

Crossing State Lines for Ambulatory Surgical Care: Exploring Claims from New York. Bogdan Savych. May 2016. WC-16-41.

Copyright: WCRI