An average of 39% of medical costs in workers compensation go toward physician expenses, according to a report released Tuesday by the National Council on Compensation Insurance.
In studying medical expenses in 2022 across 36 states, the Boca Raton, Florida-based ratings agency found wide variations in physician expenses, ranging from a low of 23% to over 50% of claim medical costs, with variances depending on such factors as type of injury and likelihood of surgeries.
The report also found that insurers pay an average of $1,812 in physician costs for workers comp claims.
In studying utilization trends, NCCI said it looked to see if common features of state medical regulations correlate with or explain variations in costs among states. Researchers considered workers compensation treatment guidelines, the use of fee schedules, and networks in investigating variations, leading the team to find “that there was not any single feature that can explain these variations.”
Yet service intensity — described in the report as the mix of medical services in a claim, many of which involve expensive surgeries — emerged as “the primary factor behind interstate variations in physician utilization for many states.”