WCRI Studies Examine Medical Costs Drivers; Reform Impacts for 17 States

The Workers Compensation Research Institute (WCRI) has published a new set of studies looking into factors driving trends of medical payments in state workers compensation systems.

Specifically, the studies—CompScope Medical Benchmarks, 16th Edition—examine the impact of legislative and regulatory changes on medical payments per claim, detailing trends in payments, prices, and utilization of medical care for injured workers.

“The reports are useful to identify where medical cost and care patterns may be changing,” said Ramona Tanabe, executive vice president and counsel for WCRI, in a statement.

According to WCRI, the studies provide a baseline of current costs and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time—covering the period from 2008 through 2013, with claims experience through March 2014.

“They also help identify where medical payments per claim or utilization may differ from other states,” Tanabe said. “In addition, where there may be concerns about restrictions on access to care, the studies can help identify potential underutilization of medical services.”

The 17 states in the study―Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin―represent more than 60 percent of the nation’s workers compensation benefit payments. There are individual reports for every state except Arkansas and Iowa.

WCRI offered some key findings about some of the states in the announcement about the publication of the studies:

• In California, medical payments per claim decreased 5 percent in 2013, likely reflecting the early impact of the 2012 workers compensation reform legislation, including reduced reimbursement rates for ambulatory surgery centers and elimination of separate reimbursement for implantables, WCRI said.
• In Illinois, medical payments per claim rose 4.1 percent in 2013, following decreases between 2010 and 2012 due to a 30 percent reduction in the fee schedule rates. WCRI traces part of the 2013 growth in medical payments per claim to annual updates in the fee schedule rates, which are tied to the changes in the Consumer Price Index.
• In New Jersey, medical payments per workers compensation claim were stable from 2010 to 2013, in contrast to rapid growth in the prior two years. Factors may include increased use of networks, stable utilization of services by nonhospital providers, and decreased percentage of inpatient episodes, WCRI said.
• In Texas, medical payments per workers compensation claim rose 7 percent in 2013, largely driven by an increase in payments for hospital inpatient episodes. The trend in Texas was about twice the average annual increase from 2008 to 2012.

WCRI also reported that medical payments per claim in Virginia were among the highest of the study states, driven primarily by prices.

For more information about these studies, visit http://www.wcrinet.org/result/csmed16_all_result.html.