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WCRI Chart ASCs vs. Hospitals Shows Interesting 18 State Comparison

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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.  

WCRI Chart ASC Hospital Comparison 18 State Study
(c) WCRI – Boston MA

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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James Moore

Raleigh, NC, United States

About The Author...

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.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

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.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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