In-network workers comp providers offer lower prices: Report
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An increasing amount of workers compensation payments are going to in-network providers, whose prices tend to be lower than out-of-network prices and who offer lower costs for opioids and other medications, according to a report from the National Council on Compensation Insurance.
The Boca Raton, Florida-based ratings provider examined the use of networks to care for injured workers and compared the impact of in-network vs. out-of-network prices, services and injury type in the report released in late March.
The workers compensation industry has seen a significant and steady increase in the use of medical provider networks, with 78% of payments going to in-network providers in 2016 compared with 70% in 2011, according to the report. In-network and out-of-network price departures have remained stable at about 13% and 5% below the maximum allowable reimbursement, respectively.
In states with physician fee schedules, the share of payments at or above the fee schedule maximum were greater for out-of-network services than in-network services, with 87% of in-network payments below the fee schedule’s maximum allowable reimbursement vs. 66% for out-of-network services.
In-network providers did tend to use more evaluation and management as well as physical medicine per claim compared with out-of-network providers, and in-network providers tended to have a slightly higher proportion of more complex evaluation and management visits compared with out-of-network providers, the report said.
Out-of-network claims also had greater drug costs, with opioid drug costs approximately double for out-of-network claims vs. in-network and non-opioid drug costs about a third more for out-of-network.
