This study examines medical payments, prices, and utilization in Florida and compares them with 17 other states (Arkansas, California, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin). It also monitors how these metrics have changed from 2011 to 2016. Claims with experience through March 2017 for injuries up to and including 2016 were analyzed.

Florida implemented medical fee schedule changes for all providers in 2015 and 2016. Results in this study reflects up to 27 months of experience after the hospital fee schedule change and 15 months after the ambulatory surgery center fee schedule update. Also discussed is the one-year experience following the professional fee schedule change.

In addition, the Castellanos and Westphal decisions issued by the Florida Supreme Court in 2016 are expected to affect costs and litigation expenses in the state’s workers’ compensation system. With data reflecting up to 10–12 months of experience after the two decisions, the findings from this study primarily reflect payments, prices, and utilization of medical services among different providers prior to these court rulings.

CompScope™ Medical Benchmarks for Florida, 19th Edition. Rui Yang. October 2018. WC-18-25.

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