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Workers comp-related medical payments higher than others: WCRI

Workers comp-related medical payments higher than others: WCRI

Medical payments made in relation to workers compensation-related treatments are typically higher than group health medical payments in a majority of states, according to a study released Friday by the Workers Compensation Research Institute.

The Cambridge, Mass.-based WCRI showed that shoulder surgeries in Virginia that were reimbursed under workers comp plans cost 115%, or $6,051, more than similar procedures paid under group health plans. In Florida, such procedures cost 98%, or $5,514, more than similar procedures paid by group health.

Workers comp payments for outpatient knee surgeries were 116%, or $4,023, higher in Virginia compared with group health payments for such procedures in the state, the WCRI showed. Florida payments for comp-related knee surgeries were 101%, or $4,240, higher, while comp-related payments in Illinois and Louisiana were 74% higher, or $3,289 and $3,149 respectively.

“For this difference in payments in hospital services to be necessary, the additional burden that the workers compensation system places on hospital providers (e.g., additional paper work, delays and uncertainty in reimbursements, formal adjudication, and special focus on timely return to work) must be sizable,” the report reads. “If this is the case, policymakers have special opportunities to reduce medical payments by modifying state statutes and regulations.”

Comp-related medical costs tended to be higher in states that have workers comp fee schedules based on a percentage of the typical fees paid for medical services, the WCRI said. That's compared with states that have a fixed-amount fee schedule or no fee schedule at all for workers comp treatments.

WCRI's report can be found here.