The Workers’ Compensation Research Institute’s (WCRI) “CompScope Medical Benchmarks for North Carolina, 20^th Edition,” shows that medical payments per claim in the state have decreased year after year since 2014. The authors of the study attribute that to fee schedule changes in hospitals and ambulatory surgery centers (ASCs) and for nonhospital (professional) services.

https://www.wcrinet.org/

The study compared North Carolina benchmarks to 17 other state workers’ comp systems looking at claims with experience through 2018, for injuries up to and including 2017. They found that medical payments per claim decreased 5 to 7 percent per year since 2014.

In 2015 there were reforms in the comp system to target hospital costs. Fee schedule rules set reimbursement for medical care that was based off a percentage of Medicare. There were phased-in decreases in reimbursement for hospitals and ASCs as well as changes in reimbursement for nonhospital (professional) services.

“Medical payments per claim decreased 5 percent per year from 2012 to 2017 for claims with more than seven days of lost time at 12 months of experience- more than in any other state during that period,” said Ramona Tanabe, executive vice president and counsel of WCRI.

The average medical payment per claim was 28 percent lower than the median of all the 18 states studied, for 2017 claims with more than seven days of lost time at an average of 12 months of experience. Prior to the new fee schedule rates, medical payments in North Carolina were closer to the median.

They also found nonhospital prices paid overall increased 8 percent per year from 2014 to 2016. There was little change in prices paid for 2017 and 2018.

Other observed effects following the adoption of the Medicare-based fee schedules included decreases in ASC facility payments per claim, and in hospital payments per inpatient episode. From 2014 to 2017 the percentage of medical payments for care in networks increased.

Read more here and check out the study at WCRI.