Evaluation of the 2015 and 2016 Fee Schedule Changes in Delaware

By Rebecca (Rui) Yang, Olesya Fomenko, Te-Chun Liu

February 1, 2017 Related Topics: Ambulatory Surgery Centers, Fee Schedules

This study evaluates the early impact of Delaware House Bill (HB) 373, which had a goal to reduce medical expenses in the state’s workers’ compensation system by 33 percent over three years. It discusses the impact HB 373 had on fee schedule rates and the actual prices paid for professional services. For hospital outpatient services and ambulatory surgery center (ASC) services, the study addresses the legislation’s potential impact by comparing the established fee schedule rates with the actual pre-change payments. 

To provide some context on where Delaware stands with respect to other states, the study compared the workers’ compensation professional fee schedules in Delaware for the pre-change and post-change years with fee schedule rates in other states as of 2016. It also compared pre-change workers’ compensation hospital outpatient payments and post-change fee schedule rates in Delaware with hospital outpatient payments in 32 other states for the most common knee surgery. Similar analysis was conducted for ASC services.

Copyright: WCRI

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Research Questions:

  • What impact did HB 373 have on professional fee schedule rates, professional prices paid, hospital outpatient services, and ambulatory surgery center (ASC) services?
  • How do Delaware’s pre- and post-change workers’ compensation professional fee schedule rates compare with other states as of 2016?
  • How do Delaware’s pre-change workers’ compensation hospital outpatient payments and post-change fee schedule rates in Delaware compare with hospital outpatient payments in 32 other states for the most common knee surgery?
  • How do Delaware’s workers’ compensation fee schedule rates and Medicare rates compare for professional services, hospital outpatient and inpatient services, and ASC services in Delaware?

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