States without workers' compensation fee schedules have higher hospital outpatient/ambulatory surgical center costs for common surgeries compared to states with fee schedules, according to research conducted by the Workers Compensation Research Institute.
The study measures hospital outpatient/ASC costs actually paid from 2003-2009. It focuses on services that are associated with the most common surgeries performed in workers' compensation cases since surgery-related costs make up approximately 60-70 percent of all outpatient costs.
The states included in the study, which represent 60 percent of the workers' compensation benefits paid in the United States, include California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin.
Key findings from the WCRI study include the following:
• The costs in states without fee schedules were 27-73 percent higher than the median of states with fee schedules.
• States with fee schedule regulations that were based on a percentage-of-charges had higher costs compared to states with other types of fee schedules, such as ambulatory payment classification-based fee schedules, with the exception of Illinois.
• Additionally, after fee schedule changes, growth in hospital outpatient/ASC costs resumed at faster rates in states with fee schedule regulations that were based on a percentage-of-charges.
• Significant variations in hospital outpatient/ASC costs were also found across states. The average hospital outpatient/ASC cost per surgical case in Massachusetts — the state with the lowest costs — was 60 percent lower than the median study state, while the average cost in Illinois — the state with the highest costs — was 45 percent higher, as of 2009.
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The study measures hospital outpatient/ASC costs actually paid from 2003-2009. It focuses on services that are associated with the most common surgeries performed in workers' compensation cases since surgery-related costs make up approximately 60-70 percent of all outpatient costs.
The states included in the study, which represent 60 percent of the workers' compensation benefits paid in the United States, include California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin.
Key findings from the WCRI study include the following:
• The costs in states without fee schedules were 27-73 percent higher than the median of states with fee schedules.
• States with fee schedule regulations that were based on a percentage-of-charges had higher costs compared to states with other types of fee schedules, such as ambulatory payment classification-based fee schedules, with the exception of Illinois.
• Additionally, after fee schedule changes, growth in hospital outpatient/ASC costs resumed at faster rates in states with fee schedule regulations that were based on a percentage-of-charges.
• Significant variations in hospital outpatient/ASC costs were also found across states. The average hospital outpatient/ASC cost per surgical case in Massachusetts — the state with the lowest costs — was 60 percent lower than the median study state, while the average cost in Illinois — the state with the highest costs — was 45 percent higher, as of 2009.
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