Medical Payments per Claim in Florida Were Typical Of Study States and Grew At A Moderate Rate from 2007 to 2012, Says New WCRI Study

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This 15th edition CompScope™ Medical Benchmarks study for Florida from WCRI examines medical payments, prices, and utilization in Florida and compares them with 15 other states. The study also provides findings from other WCRI reports to give the reader a deeper understanding of other aspects of the Florida workers’ compensation system, such as narcotics use and physician dispensing.

Sample chart from study.

Sample chart from study.

From 2007 to 2012, medical payments per claim in Florida grew 2.9 percent per year, less than the median growth of the 16 states WCRI studied, 4.5 percent.

Medical payments per claim in Florida were typical of the 16 study states and grew moderately over the study period. The WCRI report, CompScope™ Medical Benchmarks for Florida, 15th Edition, said the average cost of a Florida claim with more than seven days of lost time that occurred in 2012 was $11,519, fairly close to the 16-state median at $12,167.

From 2007 to 2012, medical payments per claim in Florida grew 2.9 percent per year, less than the median growth of the 16 states WCRI studied, 4.5 percent.

Hospital outpatient care was used less frequently in Florida compared to other study states. Both the percentage of claims with hospital outpatient services and the average number of visits per claim billed by hospital outpatient providers were among the lowest of the 16 states. However, for claims receiving hospital outpatient care, the average payment per service of Florida’s hospital outpatient services was higher than any other study state, 60 percent higher than the 16-state median.

While the average payment per outpatient service was the highest of all states, the number of outpatient services performed per claim was the lowest. The two measures largely offset, giving an average hospital outpatient cost per claim near the 16-state median.

WCRI observed that the average payment per service for hospital outpatient services in Florida grew rapidly at 7.5 percent per year from 2007 to 2012. This trend may be related to some features in the percent-of-charge-based fee schedule in the state. For example, the average payment per service for hospital outpatient operating rooms grew 12 percent per year over the study period, closely following the increase of 13 percent per year in charges per service.

Among other major findings:

  •     Florida had higher percentages of outpatient shoulder and knee surgeries done in ambulatory surgery centers (ASCs), and the average ASC payment per episode for those surgeries was in the middle group of study states.
  •     Prices paid for professional services in Florida were among the lowest of the study states, while utilization of nonhospital care was relatively higher. Both metrics remained fairly stable over the study period.

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

Click on the following link to purchase a copy of this study


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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Andrew Kenneally
Workers Compensation Research Institute
+1 (617) 661-9274 Ext: 257
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since: 06/2011
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