Do Higher Fee Schedules Increase the Number of Workers’ Compensation Cases?

By Olesya Fomenko, Jonathan Gruber

April 1, 2016 Related Topics: Fee Schedules

Policymakers have always focused on the impact fee schedules have on access to care as well as utilization of services. This study shines a light on an issue that policymakers and other system stakeholders might not be thinking of, which is that physicians may call an injury work-related in order to receive a higher reimbursement for care he or she provides to the patient.

According to previously published WCRI research, in many states, workers’ compensation pays higher prices than group health. Currently, 43 states have physician fee schedules that set maximum prices for health care providers to be paid, and the established fee schedule rates vary widely across states.

Do Higher Fee Schedules Increase the Number of Workers' Compensation Cases? Olesya Fomenko and Jonathan Gruber.  April 2016. WC-16-21.


Copyright: WCRI

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Research Questions:

  1. When fee schedules are higher, are cases more likely to be shifted to workers' compensation from other payors?
  2. If so, what is the size of the case-shifting effect?

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