Medical Payments Per Claim Highest for Workers in La.

The average payment per claim for the medical care of injured workers in Louisiana was nearly one-third higher than typical of states examined in a study by Cambridge, Mass.-based Workers Compensation Research Institute (WCRI).

According to WCRI, the study of 12 important states, which account for more than 50 percent of the benefits paid in the nation’s workers’ compensation system, found that in Louisiana, the average medical payment per workers’ compensation claim was 30 percent higher than the 12-state median.

For claims involving the more serious injuries—those with more than seven days of lost time—the main driver behind the higher medical payments per claim was more visits per claim to medical care providers. For these claims, the average medical payment per claim in Louisiana was $8,072—20 percent higher than the 12-state median of $6,736. At the same time, medical payments per claim for claims with seven days of lost time or less were 38 percent higher than the typical study state.

While overall prices were typical, the study noted that prices for physical medicine services—chiropractic care, occupational and physical therapy—and for office visits were higher than typical of the study states. This is not surprising since Louisiana has a higher than typical fee schedule in these areas.

The data in the reference work, “The Anatomy of Workers’ Compensation Medical Costs and Utilization: Trends and Interstate Comparisons, 4th Edition,” identifies where workers’ compensation medical dollars go and how costs and utilization differ across 12 large states.

In addition to Louisiana, the states analyzed were California, Connecticut, Florida, Illinois, Indiana, Massachusetts, North Carolina, Pennsylvania, Tennessee, Texas and Wisconsin.

“Overall, payments per claim for the medical care of injured workers in Louisiana were significantly more costly than most states in this study,” said Dr. Richard Victor, executive director of the independent, not-for-profit research organization.

Average payments per claim to providers of physical medicine services were 30 percent higher than the 12-state median.

For chiropractors, this was the result of higher average prices, while for occupational and physical therapists, it was the result of more services per visit and more visits per claim.

Workers’ compensation claims in Louisiana with more than seven days of lost time had 30 percent more “new patient” office visits per claim than typical of the study states.

This may mean that Louisiana workers sought more referrals or changes of medical care providers than did workers in the other study states.

The study reported that the average medical payment per claim for all claims grew by nine percent between 2000 and 2002. The average medical payment per claim rose by nearly five percent for claims with more than seven days of lost time and by more than 15 percent for those with less than or equal to seven days of lost time.

The increase in medical payments per claim generally were the result of an increase in payments per visit as well as an increase in the number of visits per claim for specific services, according to the study.

The Workers Compensation Research Institute is a nonpartisan, not-for-profit membership organization conducting public policy research on workers’ compensation, health care and disability issues. Its members include employers, insurers, governmental entities, insurance regulators and state regulatory agencies, as well as several state labor organizations.