25% of states set comp medical fees at or below Medicare
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Containing medical costs continues to be a goal among workers compensation systems nationwide, with most states using the Medicare fee schedule as a yardstick for how much to cover in medical expenses for injured workers, according to a study released Thursday.
The study by the Cambridge, Massachusetts-based Workers Compensation Research Institute, “Designing Workers’ Compensation Medical Fee Schedules, 2016,” provides policymakers with an overview of how each of the 43 states with workers comp physician fee schedules manage their costs.
According to researchers, 70% of fee-schedule jurisdictions used Medicare relative value units as a benchmark to set their fee schedule. The findings show that 25% of those states established their reimbursement rates for office visits near the Medicare level or below and about 20% established their fees for major surgery at triple the Medicare rates or more.
The study shows that, in general, the difference between workers compensation and Medicare rates varied widely from 2% below in Massachusetts and Florida to 189% above in Alaska. Massachusetts, Florida, New York, and the District of Columbia established their workers comp fee schedule rates, on average across all professional service groups, to be within 15% of Medicare rate, according to the study. Meanwhile, Alaska, Nevada, and Idaho set fee-schedule rates at levels more than double the Medicare rates.
The data in the study are from workers comp physician fee schedules as of March 31, 2016.
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