Though they leveled off in 2012, payments for hospital outpatient care constituted a growing share of total medical payments per claim. In 2012, they made up 36 percent of total medical payments, up from 29 percent in 2003.
Cambridge, MA (PRWEB) November 18, 2014
The cost of medical care to treat injured workers in Louisiana changed little in 2012. But, Louisiana workers’ compensation medical costs per claim remained higher than similar costs in many states, according to a study by the Workers Compensation Research Institute (WCRI).
The report, CompScope™ Medical Benchmarks for Louisiana, 15th Edition, found medical payments per claim in Louisiana grew faster than most states from 2007 to 2011, but changed little between 2011 and 2012.
The study also found the slowdown resulted from a decrease in hospital outpatient payments per service, fewer visits per claim for both hospital and nonhospital care (possibly related to medical treatment guidelines which went into effect in July 2011), and stable hospital payments per inpatient episode.
The earlier growth―8 percent per year for the five years ending in 2011―stemmed in large part from increasing hospital outpatient payments per claim, where Louisiana was one of the highest of the 16 states WCRI studied. That result likely reflects the state’s approach to reimbursing claims.
Louisiana’s fee schedule reimburses hospital outpatient services at 90 percent of billed charges. The state’s workers’ compensation statute, meanwhile, calls for reimbursement to be based on the mean of usual and customary charges. The conflict between the two provisions has produced considerable litigation.
The study also found the following:
- Though they leveled off in 2012, payments for hospital outpatient care constituted a growing share of total medical payments per claim. In 2012, they made up 36 percent of total medical payments, up from 29 percent in 2003.
- Medical payments per claim decreased for both nonhospital and hospital outpatient care.
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: http://www.wcrinet.org/result/csmed15_LA_result.html.
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.