Fee Schedule Rate Updates Lead to Rise in Illinois Workers’ Comp Medical Payments

Medical payments per workers’ compensation claim in Illinois rose 4.1 percent in 2013, after decreasing 20 percent between 2010 and 2012 as a result of a 30 percent reduction in fee schedule rates, according to a recent study by the Mass.-based Workers Compensation Research Institute (WCRI). Part of the 2013 growth in medical payments per claim was related to annual updates in the fee schedule rates, which are tied to the changes in the Consumer Price Index.

The report, CompScope Medical Benchmarks for Illinois, 16th Edition, said medical payments per claim were higher than most states WCRI studied but closer to the median study state than they had been before the 2011 fee schedule changes. Before the changes, Illinois’ medical payments per claim were the highest of all states studied.

The following are among some of the findings from the study:

• Utilization, which includes number of visits per claim and services per visit as well as the resource intensity of services provided, continued to be higher than in most states studied. In Illinois, utilization of physical medicine―procedures and modalities, such as exercises to develop flexibility, activities to improve function, and application of electrical stimulation―was among the highest of the study states.
• Prices paid for professional services, except for office visits, remained higher than in other states after the reduction in fee schedule rates.

“While medical payments per claim to physicians, physical/occupational therapists, and chiropractors in Illinois remained higher after the fee schedule rate reduction than in other study states,” said Ramona Tanabe, WCRI’s executive vice president and counsel, “hospital payments per claim, both inpatient and outpatient, moved in the range of typical states.”

WCRI studied medical payments, prices, and utilization in 17 states, including Illinois, looking at claim experience through 2014 on injuries that occurred in 2013 and earlier.

WCRI’s CompScope Medical Benchmark studies compare payments from state to state and across time. Copies of this report can be ordered from the WCRI website: http://www.wcrinet.org/studies/public/books/csmed16_IL_book.html.

Source: WCRI