Comp pays more than group health for comparable injuries: NCCIPosted On: Feb. 28, 2020 2:11 PM CST
Workers compensation pays more than group health to treat comparable injuries, according to a new study comparing costs for treating various injuries in 27 states.
The Boca Raton, Florida-based National Council on Workers Compensation analyzed data on 12 different common workers compensation medical conditions going back 10 years and compared the prices and quantity of care with the same injuries suffered by individuals in the group health system. NCCI found that after controlling for age and gender, workers comp paid more than group health to treat comparable injuries in all 27 states for all injuries studied.
For physician services, workers comp prices were 112% of group prices, the quantity of care was 160% of the group side, and the cost was 177% of group health. Missouri, Alabama and Virginia, respectively, had the greatest disparity between group health and workers compensation, while West Virginia, South Dakota and Oklahoma, respectively, had the lowest cost relativity.
The study revealed that workers received a higher quantity of services for injuries compared with individuals who suffered similar injuries on the group health side — and that quantity accounted for 80% of the price differential.
The biggest differences in cost were for chronic pain-related injuries, such as bursitis or low back pain, where the cost was 289% and 283% above group health, respectively; the lowest price difference was for knee ligament injuries at 114% above group heath.
In the study, men received more surgery services in workers comp than group health, though the opposite was true for women.
In terms of types of treatment, radiology showed the smallest cost differential compared with group health, and physical medicine showed the highest differential.
NCCI said the disparity between group health and workers comp costs in physical health could be due to cost sharing on the group side lowering use of those services, group plans that limit certain treatments such as manipulations, or the use of continued physical therapy in workers comp claims to justify more lost-time benefits.