Wis. Workers’ Comp Payments Rose Consistently in Recent Years

A new study by the Workers Compensation Research Institute (WCRI) shows that the average medical payment paid to injured workers in Wisconsin under the state’s workers’ compensation system rose consistently in recent years largely as the result of increased prices charged by providers of medical and hospital services.

The study of eight states – California, Connecticut, Florida, Georgia, Massachusetts, Pennsylvania, Texas and Wisconsin, which represent 40 percent of benefits paid in the nation’s workers’ compensation systems-found that in Wisconsin:

* The average medical payment per claim grew at an annual rate of 6.6 percent for 1996-1998 injuries with experience as of June 1999.

* The average price of a medical service is the highest of the eight states studied.

* The number of visits per claim is substantially lower than the eight-state average.

The reference work, The Anatomy of Workers’ Compensation Medical Costs and Utilization: Trends and Interstate Comparisons, 1996-1999, identifies where workers’ compensation medical dollars go and how costs and utilization differ across the eight states previously mentioned.

The rise in the average medical payment per claim is primarily a function of a sustained (5.8 percent) increase in the average payment per service over the three-year period.

The fact that Wisconsin has the highest payment per service overall and it continues to grow faster than inflation is not surprising, the study pointed out, given that the fee schedule is based on usual and customary charges in the state. “Because prices are higher in Wisconsin than other states for similar services, this presents an opportunity for decision makers to consider actions to reduce prices to more typical levels lowering overall medical costs below the average of the eight states studied,” concluded Stacey Eccleston, senior analyst at WCRI and the study’s lead author.

Also discovered was that despite the higher prices, the average payment per claim in Wisconsin of $5,200 is close to the eight-state median of $5,334. The medical claim costs in Wisconsin are characterized by fewer visits per claim and higher payments per service than are found in the other states studied.

The average payment per service for non-hospital providers ($127) is substantially higher than the median state ($91), according to the study. There are fewer visits per claim to doctors and physical and occupational therapists and fewer services per visit for chiropractors.

The study observed that it is possible that providers in Wisconsin treat with more intensive, more costly services but require fewer visits. On the other hand, the services may be the same as those in other seven states but simply higher priced. Additionally, minor surgery, minor radiology and physical medicine are paid for in Wisconsin at prices that are typically 40 percent higher than the eight-state average. Office visits also are paid at significantly higher prices.

Topics Workers' Compensation Wisconsin