Cambridge, MA – Medical payments per workers’ compensation claim with more than seven days of lost time in Massachusetts were the lowest of 18 states studied. This reflects both lower prices paid and utilization of services based on 2014 to 2016 claims evaluated as of 2017, according to a recent study by the Workers Compensation Research Institute (WCRI).
“Massachusetts’ lower–than-typical medical payments per claim are primarily a result of fee schedules for professional and hospital services and utilization control,” said Ramona Tanabe, WCRI’s executive vice president and counsel.
The study, CompScope™ Medical Benchmarks for Massachusetts, 19th Edition, can help policymakers and other stakeholders in the system identify current cost drivers and emerging trends in payments, prices, and utilization of medical services among nonhospital and hospital providers. The report also examined how these metrics of medical payments in Massachusetts compared with 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through 2017 for injuries up to and including 2016.
The main reason for stability in prices paid in Massachusetts was the lack of updates in fee schedule rates for professional services since 2009. In addition, there were no other major changes in the system that would affect the trends in medical payments per claim in a material way.
“Massachusetts is different than most study states,” said Tanabe. “Not only were many services provided by hospital-affiliated practices, but also major surgery occurred less often than in the other states.”
The following are among the study’s other findings:
- Between 2011 and 2016 (claims with an average maturity of 12 months), medical payments per claim grew little or increased moderately for some provider types. The trends in Massachusetts were similar to other study states.
- A higher-than-typical percentage of claims received services billed by hospitals in Massachusetts, related to hospital-affiliated practices. However, hospital outpatient payments per claim and hospital payments per inpatient episode were lower than in other states.
- Massachusetts had lower-than-typical fee schedule rates for many professional services. Prices paid were lower than in other states for frequently used services such as evaluation and management and physical medicine. However, prices paid were typical to higher for expensive services such as major surgery, major radiology, pain management injections, and neurological/neuromuscular testing.
- Massachusetts had lower-than-typical surgery-related facility payments per claim, except for professional payments to surgeons. The percentage of claims with major surgery in Massachusetts was the lowest of the study states at all claim maturities.
Learn more or purchase a copy: WCRI: CompScope™ Medical Benchmarks for Massachusetts, 19th Edition