Study: Workers Comp Medical Payments Higher than in Group Health

Study Workers Comp Medical Payments Higher than in Group Health

Study: Workers Comp Medical Payments Higher than in Group Health

A new study released in June by the Workers Compensation Research Institute (WCRI) reveals that when it comes to workers’ compensation-related treatments, medical payments are typically higher than those paid under group health plans. The study compared prices paid by commercial insurers and by workers’ compensation payors for medical services delivered by professionals (not facilities). It focused on the median non-hospital price paid for five common surgeries and four common established patient office visits in 22 large states for services delivered in 2009. These are the prices actually paid for professional services billed under a specific Current Procedural Terminology (CPT) code.

For example, the study showed that shoulder surgeries in Virginia that were reimbursed under workers’ comp plans cost 115%, or $6,051, more than similar procedures paid under group health plans. In Florida, such procedures cost 98%, or $5,514, more than similar procedures paid by group health. The WCRI study also showed that workers’ comp payments for outpatient knee surgeries were 116%, or $4,023, higher in Virginia compared with group health payments for such procedures in the state. Florida payments for comp-related knee surgeries were 101%, or $4,240, higher, while comp-related payments in Illinois and Louisiana were 74% higher, or $3,289 and $3,149 respectively.

According to the report: “For this difference in payments in hospital services to be necessary, the additional burden that the workers’ compensation system places on hospital providers (e.g., additional paper work, delays and uncertainty in reimbursements, formal adjudication, and special focus on timely return to work) must be sizable. If this is the case, policymakers have special opportunities to reduce medical payments by modifying state statutes and regulations.”

Comp-related medical costs tended to be higher in states that have workers’ comp fee schedules based on a percentage of the typical fees paid for medical services, the WCRI said. This is compared with states that have a fixed-amount fee schedule or no fee schedule at all for workers comp treatments.

The 22 states included in this study are: Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin.

Caitlin-Morgan provides sound Workers’ Compensation solutions for diverse industries in addition to risk management services to help mitigate risk and stem losses. We can help you with your insureds’ Workers’ Comp and safety programs. Just give us call at 877.226.1027.

Sources: WCRI, Business Insurance