Cambridge, MA (WorkersCompensation.com) - Medical payments per workers' compensation claim in North Carolina decreased 6 percent per year since 2013, according to a recent 18-state study by the Workers Compensation Research Institute (WCRI).
The recent decrease is a contrast with previous trends in the state. Medical payments per claim changed little from 2010 to 2013 after increasing 4 to 6 percent per year from 2004 to 2010 at all claim maturities.
“Policy changes in recent years have targeted a key cost driver of workers' compensation claims in North Carolina—hospital costs," said Ramona Tanabe, WCRI's executive vice president and counsel.
The study, CompScope™ Medical Benchmarks for North Carolina, 19th Edition, examined medical payments per claim, prices, and utilization in North Carolina and compared them with 17 other states. It also examined how these metrics of medical costs and care have changed primarily from 2011 to 2016. For the study, WCRI analyzed workers' compensation claims with experience through 2017 for injuries up to and including 2016.
New medical fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare as required under House Bill 92, which was passed in July 2013. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect in April 2015, while changes in reimbursement for nonhospital (professional) services became effective in July 2015.
“Those changes are mostly reflected in the medical data we report, with up to 24 months of experience under the hospital and ASC fee schedules and up to 21 months of experience following implementation of the new nonhospital fee schedule,” said Tanabe.
The following are among the study's other findings:
Medical payments per claim with more than seven days of lost time in North Carolina were 19 percent lower than the median of the 18 study states for 2016 claims evaluated in 2017 (reflecting much of the 2015 fee schedule changes). In contrast, prior to the new fee schedule rules, North Carolina was similar to the median state for 2014 claims at 12 months and 36 months of experience.
Since 2014, medical payments per claim decreased for hospitals and were stable for nonhospital care. The recent medical trends likely reflect results from new fee schedule rules.
Following the 2015 fee schedule changes, hospital payments per claim were lower than typical for 2016 claims at 12 months of experience, but they had been higher than in many of the states studied in prior years. Payments per claim for nonhospital care were also lower than typical in North Carolina, driven mainly by lower prices for some services and lower ASC facility payments per claim.
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