Evaluation of the 2015, 2016, and 2017 Fee Schedule Changes in Delaware

By Olesya Fomenko, Te-Chun Liu

November 14, 2017 Related Topics: Ambulatory Surgery Centers, Fee Schedules

This new report provides policymakers and other stakeholders with the ability to examine all three rounds of the Delaware fee schedule changes enacted in House Bill (HB) 373. The objective of the fee schedule changes in HB 373 was to reduce medical expenses by 33 percent by January 31, 2017, over three consecutive annual reductions—a 20 percent reduction in 2015 and additional 5 and 8 percent reductions in 2016 and 2017, respectively. Per HB 373, Delaware transitioned to Medicare-based fee schedules for professional services, hospital inpatient and outpatient services, and ambulatory surgery center (ASC) services effective January 31, 2015.

The medical services covered in the analysis are professional medical services, hospital outpatient and ASC facility services related to surgical procedures, and hospital inpatient services. For all of these services, the study monitors workers’ compensation fee schedule changes over three years and offers a comparison between the workers’ compensation fee schedule rates and Medicare rates in Delaware. For professional services, the analysis also includes an evaluation of the impact on prices paid as a result of the 2015 and 2016 changes. Also examined is the impact of these changes on interstate rankings of Delaware for professional services, hospital outpatient services, and ASC services.

Evaluation of the 2015, 2016, and 2017 Fee Schedule Changes in Delaware. Olesya Fomenko and Te-Chun Liu. November 2017. WC-17-52.

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Research Questions:

  • What were the impacts of the 2015, 2016, and 2017 workers’ compensation fee schedule changes on the allowable reimbursement rates for professional services, hospital inpatient and outpatient services, and ASC services in Delaware?
  • How do the Delaware fee schedules for professional services, hospital inpatient and outpatient services, and ASC services compare with Medicare rates for the pre- and post-change years?
  • How did the 2015 and 2016 fee schedule changes impact actual prices paid for professional services in Delaware?
  • What was the impact of these changes on Delaware’s interstate rankings for professional, hospital outpatient, and ASC services?

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