Hospitals Paid More For Surgeries On Injured Workers: Report

A 16-state study shows that in half of the study states hospital outpatient payments for shoulder surgeries in workers’ compensation were at least $2,000 higher than those in group health.

The study from the Workers’ Compensation Research Institute is the first to compare hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation, according to WCRI.

“These are large differences in costs in many states,” Richard Victor, WCRI’s executive director, said in a statement. “Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers.”

The study also found that workers’ comp payments exceeded group health payments by the most in states where the price regulations were based on a percent of the hospital’s charges or had no hospital price regulation.

The study compares hospital outpatient payments made by workers’ comp and group health for treatment of common surgical cases in 16 large states, which represent 60 percent of the workers’ comp benefits paid in the United States, and covers hospital outpatient services delivered in 2008.

Given that most study states, except Illinois, North Carolina, and Texas, did not have substantial changes in their fee schedule regulations after 2008, the interstate comparisons should provide a reasonable approximation for current state rankings in workers’ comp versus group health payment differences, according to WCRI.

WCRI is an independent, not-for-profit research organization based in Cambridge, Mass.

Topics Legislation Workers' Compensation