December 15, 2017

WCRI: Medical Payments per Claim in Florida Typical, Grew at Moderate Rate

Cambridge, MA – Medical payments per claim in Florida were typical of the 16 study states and grew moderately over the study period. The WCRI report, CompScope™ Medical Benchmarks for Florida, 15th Edition, said the average cost of a Florida claim with more than seven days of lost time that occurred in 2012 was $11,519, fairly close to the 16-state median at $12,167.

From 2007 to 2012, medical payments per claim in Florida grew 2.9 percent per year, less than the median growth of the 16 states WCRI studied, 4.5 percent.

Hospital outpatient care was used less frequently in Florida compared to other study states. Both the percentage of claims with hospital outpatient services and the average number of visits per claim billed by hospital outpatient providers were among the lowest of the 16 states. However, for claims receiving hospital outpatient care, the average payment per service of Florida’s hospital outpatient services was higher than any other study state, 60 percent higher than the 16-state median.

While the average payment per outpatient service was the highest of all states, the number of outpatient services performed per claim was the lowest. The two measures largely offset, giving an average hospital outpatient cost per claim near the 16-state median.

WCRI observed that the average payment per service for hospital outpatient services in Florida grew rapidly at 7.5 percent per year from 2007 to 2012. This trend may be related to some features in the percent-of-charge-based fee schedule in the state. For example, the average payment per service for hospital outpatient operating rooms grew 12 percent per year over the study period, closely following the increase of 13 percent per year in charges per service.

Among other major findings:

  • Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
  • Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.

Click here to purchase a copy of this study: WCRI: CompScope™ Medical Benchmarks for Florida, 15th Edition

Source: WCRI

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