Payments for Hospital Care Drove Medical Care Costs per Claim for Injured Workers in Virginia

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Medical payments per claim have attracted considerable attention from Virginia policymakers and stakeholders. This WCRI study, CompScope™ Medical Benchmarks for Virginia 14th Edition, examines medical costs, prices, and utilization in Virginia and compares it with 15 other states.

Sample chart from study.

Sample chart from study.

Virginia is one of the states that does not regulate payments for hospital services. WCRI has found states with no fee schedule or a percent-of-charge-based fee schedule have higher costs compared with states with a per-procedure-based fee schedule.

The costs of medical care per claim for injured workers in Virginia were among the highest of any state in a 16-state study by the Workers Compensation Research Institute (WCRI).

The study, CompScope™ Medical Benchmarks for Virginia 14th Edition, shows medical payments per workers’ compensation claim in Virginia were 22 percent higher than the median of the study states.

“Virginia is one of the states that does not regulate payments for hospital services,” said Ramona Tanabe, WCRI’s deputy director and counsel. “WCRI has found states with no fee schedule or a percent-of-charge-based fee schedule have higher costs compared with states with a per-procedure-based fee schedule.”

Among the study’s findings:

  • Higher prices for nonhospital services and higher payments per service for hospital outpatient providers were the major cost drivers for medical care in Virginia.
  • Hospital payments per claim for both outpatient and inpatient services were among the highest of the study states.
  • Growth in medical payments in Virginia changed little between 2010 and 2011, after growing at an average of 7.2 percent per year prior to 2011.
  • Stable medical payments per claim between 2010 and 2011 reflected two offsetting factors: an increase in prices paid for medical care and a decline in utilization of medical services.

Click on the following link to purchase a copy of this study: http://www.wcrinet.org/result/csmed14_VA_result.html.

The Cambridge-based WCRI is recognized as a leader in providing credible, high-quality, and objective information about public policy issues involving workers' compensation systems.

ABOUT WCRI:

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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Workers Compensation Research Institute
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