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Limited regulation leads to higher outpatient costs for injured workers: Study

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Limited regulation leads to higher outpatient costs for injured workers: Study

Hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules for injured workers, according to study released Thursday by the Cambridge, Massachusetts-based Workers Compensation Research Institute.

The study found that states with percent-of-charge-based fee regulations had higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules: 37% to 151% higher than the median of the study states with fixed-amount fee schedules in 2015. 

Meanwhile, states with no fee schedules also had higher hospital outpatient payments per episode — 44% to 136% percent higher than the median of the study states with fixed-amount fee schedules in 2015. 

The annual study compared hospital payments for a group of common outpatient surgeries in workers compensation across 35 states that make up 88% of the benefits paid in the United States. 

“Rising hospital costs have been a focus for public policymakers and system stakeholders in recent policy debates in many states,” said Ramona Tanabe, WCRI’s executive vice president and in-house counsel, in a press statement. “This study will help policymakers and stakeholders conduct more meaningful comparisons of hospital payments across states, as well as to monitor the hospital payment trends in relation to reforms of hospital outpatient fee regulations.”

 

 

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