In Louisiana, Medical Payments per Workers’ Compensation Claim Stable

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This WCRI report, CompScope™ Medical Benchmarks for Louisiana, 16th Edition, found medical payments per claim with more than seven days of lost time continued to be higher than most states WCRI studied.

Sample chart from the report.

Sample chart from the report.

Hospital outpatient payments are an important driver of Louisiana’s medical payments.

Growth in medical payments per workers’ compensation claim in Louisiana slowed from 2011 to 2013, in part due to decreases in utilization of hospital and nonhospital care, according to a recent study by the Workers Compensation Research Institute (WCRI).

The report, CompScope™ Medical Benchmarks for Louisiana, 16th Edition, found medical payments per claim with more than seven days of lost time continued to be higher than most states WCRI studied. The following are among some of the study’s other findings:

  •     In Louisiana, hospital outpatient payments per service grew 1.0 percent per year from 2011 to 2013, after increasing 12 percent per year from 2008 to 2011. In earlier years, growth in Louisiana was faster than that of the median state. From 2011 to 2013, hospital payments per service were fairly stable in Louisiana and in the median state.
  •     Utilization of medical care decreased from 2011 to 2013 for both hospital outpatient and nonhospital providers, largely due to fewer visits per claim. Medical treatment guidelines that recommended frequency, optimum, and maximum duration of treatment and diagnostic procedures for medical conditions were effective July 13, 2011. This WCRI study did not examine the impact of the guidelines on utilization.

“Hospital outpatient payments are an important driver of Louisiana’s medical payments,” said Ramona Tanabe, executive vice president and counsel for WCRI. The state’s fee schedule sets reimbursement at 90 percent of billed charges, but the workers’ compensation statute says reimbursement should be based on the mean of usual and customary charges. The conflicting provisions have produced considerable litigation. Louisiana policymakers and system stakeholders have focused on revising the reimbursement approach.

The report examined medical payments, prices, and utilization in Louisiana and compared them with 16 other states. It also examined how metrics of medical costs and care compared from state to state and across time. The study analyzed claims with experience through 2014 on injuries that occurred in 2013 and prior.

To order a copy of this study, visit http://www.wcrinet.org/studies/public/books/csmed16_LA_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
+1 (617) 661-9274 Ext: 257
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since: 06/2011
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