Workers’ Compensation Research Institute (WCRI) released a study on fee schedules, “Designing Workers’ Compensation Medical Fee Schedules, 2019” which provides a description and comparison of each state and their fee schedules so that policymakers looking to make changes have information that may help their decisions.

The study includes the 45 states that have fee schedules and looked at average fee schedule rates over the rates set by Medicare, finding that the data varies “substantially” from just 1% above what Medicare pays in Massachusetts to 179% above Medicare in Alaska.

WCRI last studied fee schedules in 2016 and five states have made significant changes since then. Arizona adopted the “resource-based relative value scale approach” taking into account population and provider availability. Virginia introduced a fee schedule which uses historical average expenses or charges in the community. Florida, Kentucky and North Dakota substantially changed their rates and saw double-digit growth in the overall fee schedules from 2016 to 2019.

The District of Columbia, Florida, Massachusetts and New York established their workers’ compensation fee schedule rates to be, on average, within 20% of Medicare rates. Alaska, Arizona, Idaho, Nevada, North Dakota and Virginia set fee schedule rates at levels more than double Medicare at the state level.

A fifth of the fee-schedule states established their fees for major surgery at triple the Medicare rates or more in each state. Almost a quarter of the fee schedule states established their reimbursement rates for evaluation and management services (office visits), “near or below the Medicare level”. Massachusetts, New York, Oklahoma and Wyoming had fee schedule rates for physical medicine close to or below the Medicare rate.

If fee schedule rates are set too high savings will be negligible but if rates are too low that could jeopardize access to quality care.

Find the study here and read more here.