New Concerns Over 2011 Illinois Fee Cuts

doctor's officeEven after Illinois enacted a 30 percent reduction on their workers’ comp medical fee schedules back in 2011, new research suggests that the fee schedule is still causing problems.

The Workers Compensation Research Institute took a look at the fee schedule, which prior to these changes was one of the highest in the country. What they found might raise concerns about easy access to good care for injured workers. One thing they found was that the decrease might have been too much for office visits or primary care treatments, as they are now well below Medicare or group health rates. They found that workers’ compensation prices for office visits were 18 percent lower than most group health prices. This is a nice decrease but remember the Illinois prices were one of the highest to begin with. Part of the 2011 changes created a pool of approved doctors chosen by the employer or the insurer that the worker could choose to opt in or out of, but opting out meant the employee lose a lot of incentives. The study raised the question that this decrease could mean workers comp patients might have compromised access to primary care.

On average, medical prices fell by 24 percent even though the fee schedule had been reduced by 30 percent. However the prices for surgeries increased by up to 231 percent over the prices group health insurers pay. A knee arthroscopy procedure would cost $2,845 for a workers’ comp patient but only about $1,713 for a group health patient, according to an analysis by Risk & Insurance. The study raised the point as to whether surgeons really required such a differential in fees in order to perform operations on injured workers versus other patients.

The study also found bills involving more complex office visits with higher prices were becoming more frequent than they have been before the cuts. In 2011 expenses like bill review, case management and utilization review increased by 5 percent.

Though the fee schedule may have changed, in-network contracts may have a different price and network penetration may have changed since these 2011 changes took place.

Though Illinois has made some progress, it looks like there are still some problems that need to be addressed.

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