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WCRI- live – Illinois Fee Schedule Caused 30% Reduction in Medical Costs

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Illinois Fee Schedule Reduction Causes Changes

The Illinois fee schedule reduction of 30% – blogging –  WCRI live.

30% across the board reduction by Illinois and its effects

As with most across the board cuts in WC in other states over time, the costs per claim were not reduced in total by 30%.   I am not a fan of synthetic fee schedules.   A synthetic fee schedule is one that does not follow the usual fee schedule structure as is most other states. 

Major surgery fees were not reduced.  Illinois was the third-highest state in major surgical fees post-fee schedule reduction.

Graphic of 30 % Illinois Fee Schedule Reduction
(c) 123RF

Fees for office visits, physical medicine, and pain management injections were reduced the most (25%, 27%, and 26% respectively.)

Reasons for less than 30% reduction

  • Network penetration and resulting discounts
  • Negotiated prices were not to the 30% level
  • More complex office visits than before the reduction

I think Illinois had the right idea, but as I have presented in a few articles, a straight synthetic fee schedule is not the best approach.   However, kudos to Illinois for trending down overall costs regardless of not reducing costs by 30%.   It is a start that can be adapted in the future- possibly with some of the reduction elements in Texas or other states.

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One Response

  1. I am a board certified pain specialist with 25 years of experience and 14 years of post-graduate eduction. W/C companies in Illinois are now reimbursing me for office visits at a rate that is equivalent to $120 per hour. Considering that we pay about $25 per patient in malpractice payments alone and see about 2 patients per hour, do you think that this is a reasonable fee??

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James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

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James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

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