Today’s issue of WorkCompRecap features WCRI’s recent release of a new report that found hospital outpatient payments are lower and growing slower in states with fixed-amount fee schedules.
The study compared hospital payments for a group of common outpatient surgeries in workers’ comp across 36 states (88% of workers’ comp benefits paid in the US) from 2005-2021. Key findings included that hospital payments per outpatient surgical episode in states with percent-of-charge-based fee regulations were 81-190% higher than the median of the study states with fixed-amount fee schedules in 2021. In states with no fee schedules, they were 70-138% higher. Growth in payments in non-fee schedule states ranged from 42-72%, while the payments in the median fixed-amount fee schedule state without substantial changes in regulations increased about 14% from 2011 to 2021. The study also provides a comparison between workers’ comp hospital outpatient payments and Medicare rates.