Cambridge, MA – A new 22-state study from the Workers Compensation Research Institute (WCRI) says that nonhospital prices paid for common surgeries performed on injured workers were higher than the prices paid by group health insurers for the same surgery in almost all study states.
In a number of states, the workers’ compensation prices paid for common surgeries were 2–4 times higher than the prices paid by group health insurers in the same state, says the WCRI study A New Benchmark for Workers’ Compensation Fee Schedules: Prices Paid by Commercial Insurers? In contrast, the prices paid for office visits under workers’ compensation were typically within 30 percent of the prices paid by group health insurers.
According to the study, workers’ compensation prices are very much shaped by the state fee schedules or their absence. In states with higher (lower) fee schedules, workers’ compensation prices paid were typically higher (lower). In states without fee schedules, prices paid were generally higher.
“In a typical year, 5 to 10 states have significant public policy debates about enacting new fee schedules or making major revisions to existing ones to regulate prices paid in workers’ compensation. Often, the central question debated is how high or low the fee schedule rates should be,” said Richard Victor, WCRI’s executive director. “We hope this study can help policymakers and other stakeholders ground the debate.”
This study focuses on the median nonhospital price paid for five common surgeries and four common established patient office visits in 22 large states for services delivered in 2009. These are the prices actually paid for professional services billed under a specific Current Procedural Terminology (CPT) code. This study also discusses how to generalize these results to later years.
The 22 states included in this study are Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin.
For more information about this report or to purchase a copy, click here: WCRI: A New Benchmark for Workers’ Compensation Fee Schedules: Prices Paid by Commercial Insurers?