Cambridge, MA – Medical payments per workers’ compensation claim with more than seven days of lost time were fairly stable in North Carolina from 2014 to 2019, with the average payment lower than the median of 18 states studied, according to a recent study by the Workers Compensation Research Institute (WCRI).
From 2014 to 2019, medical payments per claim in the state decreased about 2 percent per year for claims at 12 months of experience and between 4 and 8 percent per year for more mature claims. From 2014 to 2017, medical payments per claims at 12 months of experience fell 5 percent per year. They rose nearly 3 percent per year from 2017 to 2019.
“The decreases in the earlier period were driven by rapid decreases in payments for hospital outpatient and inpatient care, largely related to changes in fee schedules the state implemented in 2015,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Medical payments per claim increased for all providers from 2017 to 2019.”
The study, CompScope™ Medical Benchmarks for North Carolina, 22nd Edition, compared North Carolina with workers’ compensation systems in 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through 2020 for injuries up to and including 2019.
The following are among the study’s other findings:
- Hospital payments per inpatient episode grew 10 percent per year from 2017 to 2019 for claims at 12 months of experience.
- Hospital outpatient payments per claim grew 4 percent per year from 2017 to 2019 for claims at the 12-month maturity. Payments for most outpatient services increased, except for physical medicine, which did not change.
- Another factor in the recent growth in medical payments per claim was facility payments for ambulatory surgery centers and hospital outpatient departments. Facility payments include payments for outpatient treatment, operating, and recovery rooms usually provided in conjunction with surgical procedures, excluding surgeon fees and other surgery-related payments.
“Results from this study include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic,” Tanabe said. “The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims.”
The report was authored by Carol A. Telles.
Learn more or purchase a copy: WCRI CompScope™ Medical Benchmarks for North Carolina, 22nd Edition