Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 5th Edition

By Rebecca (Rui) Yang, Olesya Fomenko

August 1, 2016 Related Topics: Medical Costs, Hospital Outpatient Payment Index

Rising hospital costs in the treatment of injured workers receives attention from public policymakers and system stakeholders in many states. To assist in better understanding these costs, this study compares hospital outpatient payments across states and monitors the impact of fee schedule reforms. The study also includes an additional benchmark comparing workers’ compensation hospital outpatient payments and Medicare rates. This helps states better understand their hospital payments since Medicare is one of the largest payors. 

The hospital outpatient payment indices compare payments (per surgical episode) for common outpatient surgeries under workers’ compensation from state to state for each study year and the trends within each state from 2005 to 2014. The analysis captures payments for services provided and billed by hospitals, and it excludes professional services billed by nonhospital medical providers (such as physicians, physical therapists, and chiropractors) and transactions for durable medical equipment and pharmaceuticals billed by providers other than hospitals. The analysis also excludes payments made to ambulatory surgery centers. 

The 33 states included in this study represent 87 percent of the workers’ compensation benefits paid in the United States. The states are Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin. Note the 2014 workers’ compensation and Medicare comparison is conducted for 31 states. 

Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 5th Edition. Olesya Fomenko and Rui Yang. August 2016. WC-16-72.

Copyright: WCRI

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