The average medical payment per claim to injured workers in Wisconsin continued to grow at a double-digit rate, according to a new study by the Workers Compensation Research Institute (WCRI).
The study of 12 states representing more than 50 percent of the nation’s workers’ compensation benefits also found that overall workers’ compensation medical costs in Wisconsin were typical of the states studied, even though injured workers there were away from work for a shorter period than workers in the other states.
Medical payments per claim in Wisconsin have been increasing by more than 11 percent per year since 1999, the report said. The increase in medical payments per claim was largely due to increasing prices for care by medical providers and hospitals. In the case of physical medicine providers—physical and occupational therapists and chiropractors—the increase in medical payments per claim was due to increases in the number of visits per claim and services per visit.
The data in the reference work, The Anatomy of Workers’ Compensation Medical Costs and Utilization: Trends and Interstate Comparisons, 4th Edition, identify where workers’ compensation medical dollars go and how costs and utilization differ across 12 large states.
The other states in the study were California, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, North Carolina, Pennsylvania, Tennessee and Texas. The study found that average prices increased six to ten percent for all nonhospital services with the exception of radiology services, which rose slightly less.
At the same time, the study found significant increases in average prices for many hospital-billed services, including office/clinic visits, emergency services, hospital facility services associated with inpatient stays and surgery, minor surgery, major radiology and anesthesia. For these hospital services, the study generally found increases in both the number of services per claim as well as average price increases of between 10 to 20 percent.
At an average of $6,499, medical payments per workers’ compensation claim in Wisconsin were typical of the other study states, slightly below the 12-state median of $6,736. The study observed that Wisconsin’s medical payments per claim were characterized by the highest average prices for many services among the study states, but workers received fewer visits per claim.
Although the number of visits per claim was 15 percent lower than the typical study state, the average payment per visit was 20 percent higher due to higher prices. Average prices were about 41 percent higher than the median of the study states.
Higher average prices may mean that medical providers in Wisconsin treated with more intensive, costlier services over fewer visits, the study noted. On the other hand, the services may have been the same as those in other states, but simply higher priced.
The study pointed out that chiropractors may have provided services that were provided by physical therapists in other states. Physical therapists were involved in far fewer claims, while chiropractors were involved in twice as many claims as typical of the study states.
WCRI is composed of employers, insurers, insurance regulators and state regulatory agencies in the United States, Canada, Australia and New Zealand as well as several state labor organizations. The complete report is available for a fee at the WCRI Web site.
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