Wisconsin Medical Payments per Workers’ Comp Claim Among Highest in Study

A recent study by the Workers Compensation Research Institute found that medical payments per claim with more than seven days of lost time in Wisconsin were among the highest of 18 states studied and changed little from 2014 to 2019.

The study, CompScope™ Medical Benchmarks for Wisconsin, 22nd Edition, compared Wisconsin with workers’ compensation systems in 17 other states. WCRI analyzed workers’ compensation claims with experience through 2020 for injuries up to and including 2019.

The study found that prices paid for professional services grew 3% per year from 2014 to 2019. This increase was similar to changes in other states without medical fee schedules.

Additionally, payments per service for hospital outpatient services grew about 5% per year, with charges per service growing 4 percent per year between 2014 and 2018, before increasing nearly 8% in 2019.

The study cites a combination of factors that may have influenced these results. They include medical inflation, recent hospital consolidations, and changes in the characteristics and severity of claims receiving inpatient/outpatient care. Outside workers’ compensation, hospital rates in Wisconsin have been increasing about 4 percent annually.

“Higher-than-typical prices paid for professional (nonhospital) services were the main driver of Wisconsin’s higher medical payments per claim when compared with the other study states,” said Ramona Tanabe, executive vice president and counsel of WCRI. “Payments to hospitals for common outpatient surgical episodes were also among the highest of states studied. Wisconsin is one of the few states that does not regulate professional or hospital fees with medical fee schedules.”

Topics Workers' Compensation Wisconsin