Cambridge, MA – Medical payments per claim with more than seven days of lost time in New Jersey 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, according to a recent study by the Workers Compensation Research Institute (WCRI).
While New Jersey had higher prices paid than most study states, the use of medical services in a hospital outpatient setting was lower to typical, depending on the metric and claim maturity. There are two aspects of medical utilization: volume of services delivered and frequency of use.
“In New Jersey, relatively fewer claims had evaluation and management services, radiology, laboratory, and physical medicine provided in a hospital outpatient setting in 2018,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Most of the services were provided in a nonhospital setting: freestanding ambulatory surgery centers and providers not affiliated with hospitals.”
The study, CompScope™ Medical Benchmarks for New Jersey, 21st Edition, compared New Jersey with workers’ compensation systems in 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through 2019 for injuries up to and including 2018.
The following are among the study’s other findings:
- Providers of physical medicine in New Jersey delivered 23 visits per claim and 4.3 services at each visit, compared with 20 visits per claim and 3.9 services at each visit in the median study state in 2018.
- The average payment per claim to physical/occupational therapists in New Jersey grew faster than in other study states, about 6 percent per year, and was driven by prices paid, while utilization changed little.
- The average prescription payment per claim in New Jersey was among the lowest of all study states in 2017, due to lower utilization.
With many wondering what impact Coronavirus Disease 2019 (COVID-19) will have on state workers’ compensation systems, Tanabe says, “While the full impact is currently unclear, the CompScope™ studies will be a useful baseline to monitor the effects.”
The report was authored by Evelina Radeva.
To learn more or to download a copy: WCRI: CompScope™ Medical Benchmarks for New Jersey, 21st Edition