Kentucky Medical Payments per Workers’ Compensation Claim Lower Than Typical In New 18-State Study from WCRI

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This WCRI study examines medical costs and care in Kentucky's workers' compensation system and compares them with 17 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin).

Sample slide from study.

Sample slide from study.

Medical payments per claim were below those of the typical state for all types of providers. System features related to reimbursement and medical treatment likely were the main reason for those results.

Medical payments per claim in Kentucky were lower than the median of 18 states, according to a recent study from the Workers Compensation Research Institute (WCRI).

The study, CompScope™ Medical Benchmarks for Kentucky, 17th Edition, analyzed the key components of medical payments in workers’ compensation, such as prices paid for medical services, utilization of medical care, and percentages of claims with certain services.

“Medical payments per claim were below those of the typical state for all types of providers,” said Ramona Tanabe, WCRI’s executive vice president and counsel. “System features related to reimbursement and medical treatment likely were the main reason for those results.”

The following are among the study’s findings:

  • Payments per claim for providers of nonhospital services were 22 percent below that of the typical state WCRI studied.
  • Hospital outpatient payments per claim were 18 percent lower than typical.
  • Hospital inpatient payments per claim were 28 percent below the median state.
  • The percentage of claims receiving each type of service was generally typical, except for the percentage receiving hospital outpatient services, which was above the 18-state median.
  • Medical payments per claim changed little in Kentucky from 2009 to 2014, overall and for hospital and nonhospital providers.

This is the first time WCRI has examined medical payments in depth in the Kentucky workers’ compensation system.

WCRI studied medical payments, prices, and utilization in 18 states, including Kentucky, looking at claim experience through 2015 on injuries that occurred in 2009 to 2014. WCRI’s CompScope™ Medical Benchmark studies compare payments from state to state and across time.

Copies of this report can be ordered from the WCRI web site: http://www.wcrinet.org/studies/public/books/csmed17_KY_book.html.

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 - WCRI
since: 06/2011
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