Injured worker outpatient care pricier in states without fee schedule

Fee schedules can ensure workers compensation payers are not overpaying for common outpatient surgeries and other services, according to a study the Cambridge, Massachusetts-based Workers Compensation Research Institute released Thursday, finding that hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules.

States with percent-of-charge-based fee regulations had 30% to 196% higher outpatient treatment costs than the median of the study states with fixed-amount fee schedules for services in 2016, according to the study. States with no fee schedules also had higher hospital outpatient payments per episode — 38% to 143% higher than the median of the study states with fixed-amount fee schedules in 2016, researchers found.

The study Is an annual series comparing hospital payments for a group of common outpatient surgeries in workers compensation across 35 states from 2005 to 2016. The study states in total represent 87% of the workers compensation benefits paid in the United States, according to a press statement.

The study also compared workers comp payments with that of Medicare rates for treatments, finding that variation across states greater: reaching as low as 38% below Medicare fees for treatments in Nevada and as high as 502% above Medicare in Alabama.

“Rising hospital costs continue to be a focus for public policymakers and system stakeholders in many states,” Ramona Tanabe, WCRI’s executive vice president and counsel, said in the press statement.