Study: Making Workers’ Comp Medical Fee Schedules More Effective

January 14, 2008

The primary finding in a National Council on Compensation Insurance study is that fee schedules are effective at controlling workers’ compensation medical costs.

NCCI also shows that most schedules work well for primary care but not as well for specialty medicine, and their study identifies areas for possible improvement.

Cost containment is critical to maintaining a viable workers compensation system, and the rising cost of delivering healthcare services underscores the need to control workers’ compensation medical costs, according to NCCI.

Fee schedules are the oldest and most widely used device to regulate workers’ compensationmedical payments. Still, questions remain as to what makes for an effective fee schedule.Many studies compare workers’ compensation fee schedules with various other price tables.

None, however, has looked directly at how workers’ compensation fee schedules perform within the broader healthcare delivery system.

The NCCI study looks at state workers’ compensation fee schedule designs and the relationship between workers compensation reimbursements and those for employer-sponsored group health in the state.

Because workers’ compensation fee schedules have been around for so long, it is tempting to discount them as a viable tool for workers’ compensation reform. Policymakers, however, should look beyond the initial role of fee schedules as only price controls and come to view fee schedules as one way to help workers’ compensation insurers build networks that deliver high quality, readily accessible, and cost-effective medical care.

NCCI’s conclusions on the overall effectiveness of workers’ compensation medical fee schedules include:
· Most states reimburse workers’ compensation medical care at prices that are marked up above Group Health (GH)
· States without fee schedules reimburse at a higher markup over GH than states with fee schedules
· Radiology and surgery show higher markups above GH than other medical services

The study titled “December Medical Fee Schedule” is available at www.ncci.com.

Source: National Council on Compensation Insurance

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