Cambridge, MA – The Workers Compensation Research Institute (WCRI) recently released a new edition of its study on fee schedules, Designing Workers’ Compensation Medical Fee Schedules, 2019. The purpose of the study is help policymakers who are looking to adopt, reform, or update the medical fee schedule in their state workers’ compensation system.
“If you are a policymaker considering adopting, reforming, or updating a medical fee schedule, this is the study for you. WCRI’s study provides detailed descriptions about each of the 44 states and the District of Columbia’s workers’ compensation physician fee schedules and how key fee schedule design decisions were resolved as well as how the fee schedules compare,” said Ramona Tanabe, WCRI’s executive vice president and counsel.
The study highlights some of the most important design choices that public officials face in adopting, reforming, and updating a fee schedule. These decisions, which often become the center of intense policy debates, include the following:
- How high or low should the fee schedule level be set?
- How frequently should fee schedules be updated (e.g., relative values, list of procedures, etc.)?
- Should the fee schedule be based on the relative value units of different professional medical services, or based on some other metric (e.g., historical charges or usual and customary charges)?
- If based on relative value units, should the fee schedule for physician services use the relative values developed for the Medicare program or some other relative value scale?
According to the study, the fee schedule level is very important. If fee schedule rates are set too high, savings will be negligible and the fee schedule will not achieve its cost containment goal. Conversely, setting rates too low makes treating injured workers uneconomical for providers and jeopardizes workers’ access to quality care. Additionally, the state- and service group-level comparisons of the workers’ compensation fee schedules answer a common question that policymakers and stakeholders ask: “How does my state compare with other states?”
For more information or to purchase a copy: WCRI: Designing Workers’ Compensation Medical Fee Schedules, 2019.
The authors of the study are Dr. Olesya Fomenko and Te-Chun Liu.