Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 13th Edition

By Rebecca (Rui) Yang, Olesya Fomenko

May 23, 2024 Related Topics: Medical Costs, Hospital Outpatient Payment Index

With rising hospital costs a focus of public policy debates across the country, this study compares hospital outpatient payments across states and monitors the impact of fee schedule reforms from 2005 to 2022. It also includes a benchmark comparing workers’ compensation hospital outpatient payments and Medicare rates.

The study captures payments for services provided and billed by hospitals. 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 36 states in this study, which represent 88 percent of the workers’ compensation benefits paid in the United States, 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, 13th Edition. Olesya Fomenko and Rebecca Yang. May 2024. WC-24-21.


Copyright: WCRI

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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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