WCRI: States without fee schedules see cost increases for outpatient services | Workers Compensation News

Thursday, June 2, 2022 | 0

According to a study by the Workers Compensation Research Institute, hospital outpatient payments were higher and grew faster in states with percentage fee regulations or no fee schedule.

The Cambridge, Mass.-based WCRI compared hospital payments for a group of common outpatient workers’ compensation surgeries in 36 states from 2005 to 2020, accounting for 88% of compensation benefits paid. in the United States and including early data on the effects of COVID-19 on hospital payments.

According to the study released Tuesday, hospital payments per surgical episode in states with percentage-based fee regulations were 69% to 217% higher than the median of states in the study with fee schedules. flat fees in 2020. In states with no fee schedules, they were 61% to 134% higher.

WCRI also found that hospital outpatient payments per episode in most states with percentage-based fee regulations or without fee schedules grew faster than in states with fee schedules. fixed fees.

The variation in the difference between average paid worker payments and Medicare rates for a common group of procedures across all states was even greater, reaching as little as 43% (or $2,740) below Medicare in Nevada. and up to 530% (or $28,229) above Medicare in Alabama.

WCRI also analyzed major policy changes in states with recent fee schedule reforms. For example, effective July 1, 2020, Oklahoma adopted a fee schedule for outpatient hospital services. Average hospital outpatient payment for common surgical episodes in Oklahoma increased significantly in 2020, by 17%. However, after this change, Oklahoma did not change its interstate ranking in 2020 and remained among the states with relatively lower hospital outpatient payments.

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