WCRI Chart On ASC Studies Shows Need For Fee Schedules in Workers Compensation
A recent WCRI Chart (Workers Compensation Research Institute) pointed out a hidden result that was picked up at least partially by a few bloggers. The chart below comes from a study the WCRI released on November 25th.
An attempt was made to make the chart as readable as possible. Two areas came to light after examining this WCRI chart. Two anomalies – one more pronounced than the other – became apparent very quickly.
- Wisconsin, Virginia, and Lousiana all had outpatient hospital fees above $10,000
- Indiana had ASC fees that were significantly above the outpatient hospital fees – a very rare occurrence
According to the WCRI article, the end of the study period was in 2016. The particulars of the study and how to access the study are provided later in this article.
For reference – ASC is the acronym for Ambulatory Surgical Centers – standalone surgical centers.
Hospital Outpatient Fees > $10,000
The comparison WCRI chart data, therefore, included no data after Virginia enacted their fee schedule. Wisconsin still has no fee schedule. Virginia decided to institute a fee schedule after 2016. No fee schedule causes more payouts for medical treatment. (Why?)
The Workers Comp systems in Virginia and Wisconsin base their costs and Usual and Customary – the acronym is U&C. No set payment can be anticipated by the Workers Compensation carriers or self-insurers in those two states.
The charges for outpatient surgeries can only be estimated with an educated guess. Usually, hospital outpatient centers (as most medical providers) do not post what the cost of surgery will be until the bill is received by the carrier.
Indiana’s Expensive ASCs
The WCRI chart indicates ASCs are usually the same as or less expensive than the hospital-based outpatient surgery centers. Indiana tallies a large increase in ASC costs over hospital outpatient surgery centers. (Why?)
Once again, as in the above example – in 2016 Indiana had no workers compensation fee schedule. The ASCs reverted back to the U&C charges and billed workers comp payors at much higher rates than even the outpatient hospital surgical centers which are normally much higher than ASCs.
Virginia’s New Fee Schedule
Once the Virginia fees schedule kicks in, their place in the most expensive hospital-based outpatient surgical center fees should reduce by more than a nominal amount.
I am not sure if Virginia included outpatient hospital fees in their new fee schedule.
WCRI Study Info
You can read more about the study at this link If you are involved in any way with workers compensation medical payments, I recommend reading the article. The preceding link also provides info on how to obtain a copy of the study that generated the very telling WCRI chart.
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