Cambridge, MA – Medical payments per claim in Pennsylvania have been mostly stable since 2013, following growth between 2000 and 2013, according to a recent study by the Workers Compensation Research Institute (WCRI). 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 trends in medical payments per claim in Pennsylvania varied by provider type. Hospital outpatient payments per claim grew 6.7 percent per year on average from 2013 to 2018 – more than most other study states – while nonhospital payments per claim and hospital payments per inpatient episode grew 2 and 3 percent per year, respectively, over that period.
“Rapid growth in payments per service for hospital outpatient facility services was a key driver of the growth in overall payments per service because facility services are relatively more expensive services in Pennsylvania,” said Ramona Tanabe, executive vice president and counsel of WCRI. “As a result of the increases as well as changes in some of the other study states, Pennsylvania’s relative position among the study states has shifted higher on the hospital outpatient payments per claim measure.”
The study, CompScope™ Medical Benchmarks for Pennsylvania, 21st Edition, compared Pennsylvania 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:
- Overall medical payments per claim for claims with more than seven days of lost time were 10 percent higher in Pennsylvania than the median state for 2018 claims with 12 months of experience, and 16 percent higher than the median state for 2016 claims with 36 months of experience.
- A larger proportion of workers received at least one service in a hospital setting than in most study states, and hospital care represented a larger share of medical payments per claim in Pennsylvania for 2018 claims.
- Pennsylvania had typical prices paid for nonhospital services and lower payments per service for hospital outpatient services.
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 William Monnin-Browder.
Learn more or download a copy: WCRI: CompScope™ Medical Benchmarks for Pennsylvania, 21st Edition
Source: WCRI