Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 11th Edition

By Rebecca (Rui) Yang, Olesya Fomenko

May 31, 2022 Related Topics: Medical Costs, Hospital Outpatient Payment Index

This study compares hospital outpatient payments across states and monitors the impact of fee schedule reforms from 2005 to 2020. It also includes a benchmark comparing workers’ compensation hospital outpatient payments and Medicare rates. The study covers hospital outpatient services provided during the early period of the COVID-19 pandemic. 

Payments for services provided and billed by hospitals are captured in this study. Professional services billed by nonhospital medical providers (e.g., physicians, physical therapists, and chiropractors), transactions for durable medical equipment and pharmaceuticals billed by providers other than hospitals, and payments made to ambulatory surgery centers are excluded. The study also provides an analysis of major policy changes in states with recent fee schedule reforms.

The 36 states included in this study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.

Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 11th Edition. Olesya Fomenko and Rebecca Yang. May 2022. WC-22-20.

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Research Questions:

  • How do hospital outpatient payments for common surgical episodes in my state compare with other states?
  • Do hospital outpatient payments in my state grow faster or slower than in other states?
  • What is the impact of hospital outpatient fee regulations on hospital outpatient reimbursement levels and growth rates? 
  • How do hospital outpatient payments in workers’ compensation compare with Medicare for the most common group of surgical procedures?

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