Rather than inundate your in-box with multiple posts last week, I decided to delay posting on some of the research for a few days. Today, WCRI’s analysis of work comp reform’s impact.
I had to listen very quickly and type even faster while listening to WCRI’s Carol Telles discussion of the impact of reform efforts in four states…as a result I probably missed most of the really good stuff.
When IL changed their Fee Schedule in 2011, medical payments per claim dropped about 19% while overall prices paid for non-hospital services dropped 27%. What’s with the discrepancy? Did utilization or intensity of services increase to partially offset the intended 30% decrease in the fee schedule? I might’ve missed the answer…
North Carolina also tried to reduce facility costs by changing the fee schedule from one based on charges to one based on Medicare for hospitals and Ambulatory Surgical Centers – there is a progressive decrease for services each year from 2015 to 2017, resulting in inpatient at 160% of Medicare and outpatient and ASC at 200%, with no separate billing or mar-ups for surgical implants.
In our favorite state – California – the implementation of SB 863 led to slight but significant decreases in medical payments per claim after many years of continual steady inflation. This was driven by reduction of reimbursement for ASCs from 120% of medicare to 80% effective 1/1/13, the elimination of additional reimbursement for surgical implants, and as of 1/1/14, a gradual transition to a Medicare-based FS for non-hospital providers.
Not surprisingly, ASC payments per claim decreased dramatically, dropping 24% in 2013/2014. Imaging was also hit hard with a 23% drop, while physical medicine payments increased 28%. This isn’t surprising as it is consistent with CMS’ desire to increase reimbursement for cognitive services.
Interestingly, the shift to the Medicare RBRVS system resulted in a change in billing practices; the “rise in billing more complex office visits…stopped…after RBRVS transition.”
Last up was Louisiana. State-set medical treatment guidelines were introduced five years ago, and there have been slightly fewer visits per claim after that intro. The biggest drop was in pain management injections followed by a 5.7% drop in physical medicine (PT, OT, chiro).
The net – reform can effectively reduce cost if effectively targeted and well-designed.
