Wisconsin Medical Payments per Workers’ Comp Claim Trending Higher

November 20, 2017

A new study by Cambridge, Massachusetts-based Workers Compensation Research Institute (WCRI) found that Wisconsin’s medical payments per workers’ compensation claim were higher than typical for 2015 injuries evaluated as of March 2016.

The study, CompScope Medical Benchmarks for Wisconsin, 18th Edition, examined the costs, prices and utilization of workers’ compensation medical care in Wisconsin compared to 17 other states.

The following are among the WCRI study findings:

  • In 2015, Wisconsin’s workers’ compensation medical payments per claim with more than seven days of lost time were 61 percent higher than the median study state; medical payments per all paid claims were 46 percent higher than typical. Prior editions of the CompScope report showed Wisconsin’s average medical payments as being closer to the median study state.
  • Substantially higher prices paid for nonhospital medical services contributed to higher average medical payments. Utilization of nonhospital medical services in Wisconsin was among the lowest of the study states.
  • Payments per claim for nonhospital services increased 3 percent annually from 2010 through 2015, driven more by price increases than utilization.
  • Hospital outpatient payments per claim increased 4.7 percent per year, on average. Increases in payments per service contributed to this trend; there was little change in utilization of hospital outpatient care.
  • In 2015, Wisconsin had among the highest percentages of claims receiving hospital outpatient care, due primarily to a higher percentage of workers receiving radiology, physical medicine and office visits from hospital outpatient providers.
  • Overall total costs per all paid claims were lower than typical in Wisconsin, driven largely by fewer workers losing time from work after an injury, substantially lower indemnity payments per claim and shorter duration of temporary disability benefits.

WCRI studied medical payments, prices and utilization in 18 states, including Wisconsin, looking at claim experience through 2016 on injuries that occurred mainly in 2010 to 2015.

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