https://www.wcrinet.org/

The Workers’ Compensation Research Institute (WCRI) released their study titled ‘Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 7^th Edition” that compares outpatient payments across states to see if fee schedule reforms had any impact. The study also includes benchmark data comparing workers’ comp outpatient payments to Medicare rates.

The study looked at services provided and billed by hospitals, excluding professional services billed by nonhospital providers like physical therapists, physicians and chiropractors. It also looked at transactions for durable medical equipment and pharmaceuticals billed by providers, other than hospitals. It excluded payments made to ambulatory surgery centers.

They found that outpatient payments were higher in states with a percent-of-charge-based fee regulation, or no fee schedule. States with a percent-of-charge fee schedule saw payments that were 30 to 196 percent higher than the median of states with fixed-amount fee schedules in 2016. States with no fee schedules had rates 38 to 143 percent higher than the median of states with fixed-amount fee schedules in 206. Hospital outpatient payments per episode in states with either percent-of-charge or no fee schedule grew faster than in states with fixed-amount fee schedules.

Variation between average comp payments and Medicare rates was even greater – as low as 38 percent below Medicare in Nevada (which has a fixed-amount fee schedule) and as high as 502 percent above Medicare in Alabama (which has a percent-of-charge-based fee regulation).

The study uses data from 2005 and 2016 and included 35 states.

Download the study from WCRI and read more from WorkCompWire