WCRI finds medical payments per claim among highest in Wisconsin
Medical payments per claim with more than seven days of lost time in Wisconsin were among the highest of the 18 states analyzed by the Workers Compensation Research Institute for a recent report.
“Higher-than-typical prices paid for professional (nonhospital) services were the main driver of Wisconsin’s higher medical payments per claim when compared with the other study states,” Ramona Tanabe, executive vice president and counsel of WCRI, said in a statement.
“Payments to hospitals for common outpatient surgical episodes were also among the highest of states studied. Wisconsin is one of the few states that does not regulate professional or hospital fees with medical fee schedules.”
Other findings in the 22nd edition of the CompScope Medical Benchmarks for Wisconsin include:
- Prices paid for professional services grew 3% per year from 2014 to 2019, similar to the increase in other states without medical fee schedules.
- Payments per service for hospital outpatient services grew about 5% per year, with charges per service growing 4% per year between 2014 and 2018 before increasing nearly 8% in 2019.
- The percentage of claims receiving hospital outpatient services increased, a departure from the typical state studied where fewer claims received services in hospital outpatient departments. Nearly 80% of Wisconsin claims involved hospital services.
