This study examines medical payments, prices, and utilization in the Georgia workers’ compensation system and compares Georgia with 17 other states. It also examines how these metrics have changed primarily from 2013 to 2018; though, in some cases, we used a longer time frame to provide historical context for key metrics. The report can help policymakers and other stakeholders identify current cost drivers and emerging trends in payments, prices, and utilization of medical services among nonhospital and hospital providers in the Georgia workers’ compensation system. Claims with injuries up to and including 2018 (evaluated as of 2019) were analyzed. Information from other WCRI studies was added to provide a more complete picture of the system in Georgia.

During the study period, Georgia changed its reimbursement approach for outpatient providers (both ambulatory surgery centers [ASCs] and hospital outpatient providers). Effective May 2014, the outpatient reimbursement method in Georgia changed from an ICD-9-CM-based fee schedule to a Medicare OPPS-based fee schedule. The data in this report reflect up to 59 months of experience after the fee schedule change and may help policymakers and stakeholders in the Georgia workers’ compensation system monitor the impact of this regulation change. Additionally, effective April 2018, Georgia introduced separate fee schedule rates for ASCs (at 210 percent of Medicare’s OPPS rates). The data in this report reflect up to 12 months of experience following the introduction of separate reimbursement rates for ASCs.

CompScope™ Medical Benchmarks for Georgia, 21st Edition. William Monnin-Browder. October 2020. WC-20-29.

Copyright: WCRI