Cambridge, MA – The factors behind trends in medical payments per claim in state workers’ compensation systems and the impact of legislative and regulatory changes on those costs are examined in a new set of studies released by the Workers Compensation Research Institute (WCRI).
The studies, CompScope™ Medical Benchmarks, 21st Edition, examine trends in payments, prices, and utilization of medical care for workers with injuries. They provide analyses of recent costs and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time and from state to state.
“The reports are useful to identify where medical cost and care patterns may be changing and help identify where medical payments per claim or utilization may differ from other states,” said Ramona Tanabe, executive vice president and counsel for WCRI. “While the full impact of COVID-19 on state workers’ compensation systems is currently unclear, these studies will be a useful baseline to monitor the effects.”
The following are sample findings for some of the study states:
- California: Average payments reflected the effects of multiple policy changes, including SB 863, a drug formulary and two fraud-fighting measures. The average nonhospital payment per claim has been fairly stable since 2015, decreasing 2 percent per year on average for claims at 12 months of experience, while hospital payments per claim grew 5 percent per year.
- Georgia: Medical payments were typical of other states but reflected offsetting factors: the average payment for nonhospital providers was higher than other study states and the average payment for hospital outpatient services was lower, while the average hospital payment per inpatient episode and percentage of claims with inpatient care were typical of the study states.
- Michigan: Overall stable trends in nonhospital payments mask some variation among services. Payments per claim increased for physical medicine and services such as anesthesia, drugs, legal and special reports, and supplies and equipment; payments decreased for radiology and neurological testing and were stable for other key nonhospital services.
- New Jersey: Medical payments per claim with more than seven days of lost time were about 14–21 percent higher than the median study state, depending on the claim maturity, driven largely by higher prices paid for professional (nonhospital) services.
- Pennsylvania: Medical payments per claim have been mostly stable since 2013. For claims at 12 months of experience, medical payments per claim increased 2.3 percent per year on average from 2013 to 2018, compared with growth of 7–8 percent per year on average from 2000 to 2013.
The studies cover the period from 2013 through 2018, with claims experience through March 2019. The 18 states in the study ― Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin ― represent more than 60 percent of the nation’s workers’ compensation benefit payments. Individual reports are available for every state except Arkansas, Iowa, and Tennessee.
More information: WCRI: CompScope™ Medical Benchmarks, 21st Edition .