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State workers compensation regulators who set medical fee schedule rates too low could affect access to care for injured workers, according to a study released Thursday by the Workers’ Compensation Research Institute.
In the comprehensive study on fee schedules in the 45 states that have them, researchers examined average fee schedule rates over that the rates set by Medicare and found the data “varied substantially,” from 1% above what Medicare pays in Massachusetts to 179% above Medicare in Alaska, according to the report.
Since the Cambridge, Massachusetts organization last studied fee schedules in 2016, five states — Arizona and Virginia — made significant changes. Arizona adopted the “resource-based relative value scale approach,” which takes into account population and provider availability, and Virginia introduced a fee schedule using historical actual average expenses or charges in the community, according to the report. Three states — Florida, Kentucky, and North Dakota — had “substantial changes to their fee schedule rates” resulting in double-digit growth in the overall fee schedules from 2016 to 2019, researchers found.
Overall, accessing the fee schedules in 2019, the District of Columbia, Florida, Massachusetts, and New York established their workers compensation fee schedule rates, on average across all professional service groups, to be within 20% of Medicare rates. In turn, Alaska, Arizona, Idaho, Nevada, North Dakota, and Virginia set fee schedule rates at levels more than double Medicare at the state level, according to the data.
Regarding service groups in care, about 25% of the fee schedule states established their reimbursement rates for evaluation and management services, otherwise known as office visits, “near the Medicare level or below.” Four states — Massachusetts, New York, Oklahoma, and Wyoming — had fee schedule rates for physical medicine close to or below the Medicare rate. Researchers noted that “such a level might potentially jeopardize access to quality primary and physical medicine care for injured workers.”
Meanwhile, 20% of the fee-schedule states established their fees for major surgery at triple the Medicare rates or more in each state, according to the report.
The New York Workers’ Compensation Board is proposing a medical fee schedule that would increase payments by 5% overall to improve access to medical care for injured workers by attracting more providers.