Cambridge, MA – Medical payments per claim with more than seven days of lost time were lower in Texas than the typical state in an 18-state study by the Workers Compensation Research Institute (WCRI).
Medical payments per claim were lower than typical for both hospital and nonhospital care, according to the study. Medical payments per claim were stable overall from 2014 to 2019. Payments per claim increased between 2017 and 2019, driven mainly by hospital payments per inpatient episode. Hospital outpatient payments per claim were stable over the entire period.
“The stability since 2014 masks offsetting trends within the period,” said Ramona Tanabe, executive vice president and counsel of WCRI. “For claims at 12 months of experience, for example, medical payments per claim decreased about 4 percent per year from 2014 to 2017, driven mainly by nonhospital payments, and then increased nearly 6 percent per year from 2017 to 2019.”
The study, CompScope™ Medical Benchmarks for Texas, 22nd Edition, compared Texas 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:
- Like Texas, medical payments per claim in the 18-state median increased from 2017 to 2019. However, the growth in Texas was faster than the typical state.
- A key factor in the growth from 2017 to 2019 was a double-digit increase in average hospital payments per inpatient episode, especially among nonsurgical cases. Possible factors include a higher incidence of more expensive inpatient cases, related to changes in the underlying mix of injuries and severity. For example, there were more fractures, burns, and injuries to multiple body parts in 2018 and 2019 compared with prior years.
- The stability in payments per claim for hospital outpatient care from 2014 to 2019 was the result of offsetting and shifting trends in the components. Payments for such claims at 12 months of experience increased 5 percent from 2014 to 2015 (driven by payments per service), changed little from 2015 to 2018, then increased 2.5 percent from 2018 to 2019 (driven by services per claim).
“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: WCRI: CompScope™ Medical Benchmarks for Texas, 22nd Edition.