Hospital outpatient payments in workers compensation claims are lower and growing at a slower rate in states with fixed reimbursement fee schedules compared with states that have no fee schedules, according to a study released Thursday by the Workers Compensation Research Institute.
The study, “Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 13th Edition,” looked at hospital payments for common workers comp outpatient surgeries in 36 states, which the WCRI says represent 88% of workers comp benefits paid across the country.
Researchers found that payments for outpatient procedures in states that have percent-of-charge-based fee regulations were 65% to 196% higher than the median of the study states that have fixed-amount fee schedules in 2022.
Researchers found that states with no hospital outpatient reimbursement fee schedules also had higher hospital outpatient payments per episode compared with states that have fixed-amount fee schedules.
The study also looked at workers comp hospital outpatient payments compared with Medicare rates for similar medical procedures.
The authors of the study said the findings are designed to help policymakers and industry stakeholders identify those states where hospital outpatient payments are “unusually high or low.”
The study also addressed major policy changes and fee schedule reforms.
Mississippi, for example, updated its ambulatory payment classification-based fee schedule from 2019 to 2022 Medicare values, which correlated with a 15% increase in hospital outpatient payments in 2022, the study states.