WCRI: States Without Fee Schedules See Cost Hikes for Outpatient Services

Thursday, June 2, 2022 | 0

Hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules, according to a study by the Workers Compensation Research Institute.

Cambridge, Massachusetts-based WCRI compared hospital payments for a group of common outpatient surgeries in workers' compensation across 36 states from 2005 to 2020, representing 88% of the comp benefits paid in the United States and including early data on the effects of COVID-19 on hospital payments.

According to the study released Tuesday, hospital payments per surgical episode in states with percent-of-charge-based fee regulations were 69% to 217% higher than the median of the study states with fixed-amount fee schedules in 2020. In states with no fee schedules, they were 61% to 134% higher.  

WCRI also found that hospital outpatient payments per episode in most states with percent-of-charge-based fee regulations or no fee schedules grew faster than in states with fixed-amount fee schedules.

Variation in the difference between average workers' comp payments and Medicare rates for a common group of procedures across states was even greater, reaching as low as 43% (or $2,740) below Medicare in Nevada and as high as 530% (or $28,229) above Medicare in Alabama.

WCRI also analyzed major policy changes in states with recent fee schedule reforms. For example, effective July 1, 2020, Oklahoma adopted a fee schedule for hospital outpatient services. The average hospital outpatient payment for common surgical episodes in Oklahoma grew materially in 2020, by 17%. However, after this change, Oklahoma did not change its interstate ranking in 2020 and remained among the states with relatively lower hospital outpatient payments.

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