Medical Payments per Claim Mostly Stable in Georgia Workers’ Compensation System, Finds WCRI Study
Cambridge, MA (WorkersCompensation.com) - Medical payments per claim with more than seven days of lost time have been mostly stable in Georgia since 2008, according to a recent study by the Workers Compensation Research Institute (WCRI). Payments per claim to hospital and nonhospital providers were both stable from 2013/2014 to 2018/2019.
“WCRI has tracked Georgia medical payments per claim going back to claims from injury year 2008,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Over the 10-year period from 2008 to 2018, medical payments per claim in Georgia increased less than 2 percent per year on average, which is fairly stable.”
Medical payments per claim in Georgia, which reflected offsetting factors, were typical of the study states. Nonhospital payments per claim were 13 percent higher compared with the median study state, while hospital outpatient payments per claim were 20 percent lower than the median study state. Hospital payments per inpatient episode were typical of the study states.
In 2018, Georgia made a change to its fee schedule for outpatient services, introducing separate, lower fee schedule rates for ambulatory surgery centers (ASC), as compared with hospital outpatient providers. Previously, ASCs were reimbursed at the same rates as hospital outpatient providers. ASC facility payments per claim decreased 6 percent in 2018, which likely reflects, in part, the introduction of separate fee schedule rates for ASCs. The average ASC facility payment per claim in Georgia was typical of the study states, and Georgia had a higher percentage of claims with ASC facility services compared with other study states for 2018 claims with 12 months of experience.
The study, CompScope™ Medical Benchmarks for Georgia, 21st Edition, compared Georgia with workers' compensation systems in 17 other states. For the study, WCRI analyzed workers' compensation claims with experience through 2019 for injuries up to and including 2018.
The following are among the study's other findings:
The average payment per claim for hospital outpatient services was lower than typical, as was the percentage of claims with such services.
The average hospital payment per inpatient episode and the percentage of claims with inpatient care were typical of the study states.
With many wondering what impact coronavirus disease 2019 (COVID-19) will have on state workers' compensation systems, Tanabe says, “While the full impact is currently unclear, the CompScope™ studies will be a useful baseline to monitor the effects.”