December 15, 2017

WCRI Study: FL Medical Payments per Workers’ Comp Claim Stabilized After Years of Moderate Growth

Cambridge, MA – Medical payments per workers’ compensation claim in Florida remained stable in 2015 following moderate growth from 2010 through 2014, according to a recent study by the Workers Compensation Research Institute (WCRI).

The study, CompScope™ Medical Benchmarks for Florida, 18th Edition, examined medical payments, prices, and utilization in Florida and compared them with 17 other states over a period from 2010 through 2015.

“Florida implemented several medical fee schedule changes after 2014,” said Ramona Tanabe, WCRI’s executive vice president and counsel. “This study provides a look at how hospital payments per claim in Florida have changed using data with experience up to 15 months after the 2015 hospital fee schedule changes.”

“In addition, the Castellanos and Westphal decisions by the Florida Supreme Court in 2016 are expected to affect costs and litigation expenses in the state’s workers’ compensation system,” Tanabe added. In those decisions, Florida’s highest court found the mandatory worker attorney fee schedule and the 104-week limitation on temporary total disability benefits to be unconstitutional. This study can help policymakers and other stakeholders in the system identify cost drivers and emerging trends in payments, prices, and utilization of medical services among different providers prior to these court decisions.

The following are among the study’s other findings:

  • Hospital outpatient payments per service decreased 3 percent in 2015 after rapid growth in earlier years, possibly reflecting the impact of a 2015 change in the hospital outpatient fee schedule.
  • Utilization of some nonhospital services decreased moderately in 2015, while prices paid for professional services remained stable.
  • Hospital inpatient payments per episode grew 13 percent in 2015, following the 2015 inpatient fee schedule update.
  • Payments per claim for using ambulatory surgery center facilities increased 6 percent per year from 2010 to 2015.

Compared with the other 17 study states, medical payments per claim in Florida were typical, mainly a result of lower professional prices offsetting higher hospital payments per claim in Florida.

WCRI studied medical payments, prices, and utilization in 18 states, including Florida, looking at claim experience through 2016 on injuries that occurred mainly from 2010 to 2015. WCRI’s CompScope™ Medical Benchmarks studies compare payments from state to state and across time.

To purchase a copy of the report, click here: WCRI: CompScope™ Medical Benchmarks for Florida, 18th Edition.

Source: WCRI

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