In Study of 18 States, Average Medical Payment for Indiana Workers’ Compensation Claims Higher Than Typical

Cambridge, MA (WorkersCompensation.com) - The average medical payment for workers’ compensation claims with more than seven days of lost time was higher in Indiana than the typical state in a study of 18 states, according to a recent report by the Workers Compensation Research Institute (WCRI).

Above-typical prices paid for professional nonhospital services were the main reason medical payments per claim were higher in the state.

“Facilities, particularly ambulatory surgery centers, or ASCs, contributed to the higher-than-typical payments in Indiana,” said Ramona Tanabe, executive vice president and counsel of WCRI. “The average ASC facility payment per claim was among the highest of the 18 states, and the percentage of claims with facility payments was higher than typical for both ASCs and hospital outpatient departments.”

The study, CompScope™ Medical Benchmarks for Indiana, 22nd Edition, compared Indiana with workers’ compensation systems in 17 other states. For the study, WCRI analyzed workers’ compensation claims with experience through 2020 for injuries up to and including 2019.

The following are among the study’s other findings:

• Hospital payments per claim, both overall and for inpatient and outpatient services, were fairly typical. Hospital payments per claim were among the highest of the states studied prior to the implementation of a hospital fee schedule in 2014.
• Prescription drug payments per claim were lower than the typical state studied, a result of lower payments per prescription.
• Between 2014 and 2019, the average payment per prescription in Indiana decreased 1 percent per year, the number of prescriptions per claim decreased 5 percent per year, and the proportion of claims with prescriptions decreased. The magnitudes of those changes were similar to other states studied.

“Results from this study include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic,” Tanabe said. “The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims.”

To learn more about this study or to purchase a copy, visit https://www.wcrinet.org/reports/compscope-medical-benchmarks-for-indiana-22nd-edition. The report was authored by Evelina Radeva.

The Cambridge-based WCRI is recognized as a leader in providing high-quality, objective information about public policy issues involving workers' compensation systems. 

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