Medical Payments per Workers’ Compensation Claim Rose 7 Percent in Texas in 2013, Faster than the Median State WCRI Studied

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Medical payments per workers’ compensation claim with more than seven days of lost time in Texas rose 7 percent from 2012 to 2013, a faster rate than in the median of 17 states, according to a recent study by the Workers Compensation Research Institute (WCRI). The report, CompScope™ Medical Benchmarks for Texas, 16th Edition, pointed to several factors.

Sample chart from the report.

Sample chart from the report.

Texas’ 7 percent increase was a change from most prior years. From 2008 to 2012, growth averaged a more moderate 3 percent annually, with some year-to-year fluctuation.

Medical payments per workers’ compensation claim with more than seven days of lost time in Texas rose 7 percent from 2012 to 2013, a faster rate than in the median of 17 states, according to a recent study by the Workers Compensation Research Institute (WCRI).

The report, CompScope™ Medical Benchmarks for Texas, 16th Edition, pointed to the following factors:

  •     Hospital payments per inpatient episode increased 16.6 percent from 2012 to 2013, having risen just 0.4 percent annually in the previous four years.
  •     Prices paid for office visits and physical medicine services grew moderately.
  •     Payments per claim for physical medical services increased, both in nonhospital and hospital outpatient settings. Physical medicine includes procedures and modalities such as exercises to develop flexibility, activities to improve function, and application of electrical stimulation.

“Texas’ 7 percent increase was a change from most prior years,” said Ramona Tanabe, executive vice president and counsel for WCRI. “From 2008 to 2012, growth averaged a more moderate 3 percent annually, with some year-to-year fluctuation.”

Payments per claim in Texas, though, remained lower than the typical state WCRI studied. Prices paid for some medical services remained below the norm, despite large increases. In addition, there were large decreases in utilization of medical care―though even after the decreases, Texas injured workers received more medical services than did those in other states for some key services, such as chiropractic care, office visits, and neurological/neuromuscular testing.

WCRI studied medical payments, prices and utilization in 17 states, including Texas, looking at claim experience through 2014 on injuries that occurred in 2013 and prior. WCRI’s CompScope™ Medical Benchmark studies compare metrics of medical costs and care from state to state and across time. Data in the Texas report likely reflect nearly all effects of House Bill 7, a 2005 reform focused on workers’ compensation medical costs.

To purchase a copy of this study, visit http://www.wcrinet.org/studies/public/books/csmed16_TX_book.html.

The Cambridge-based WCRI is recognized as a leader in providing high-quality, 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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Andrew Kenneally
Workers Compensation Research Institute
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