This study examines medical payments, prices, and utilization for various types of services by nonhospital and hospital providers in Georgia and compares them with 17 other states. It also examines how these metrics of medical payments and care have changed, mainly from 2014 to 2019. Claims with experience through 2020 for injuries up to and including 2019 were analyzed. In some cases, a longer period was used to supply historical context for key metrics. Information from other WCRI studies was also included 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. 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 24 months of experience following the introduction of separate reimbursement rates for ASCs.

The results we report include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic. The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims. 

CompScope™ Medical Benchmarks for Georgia, 22nd Edition. William Monnin-Browder. October 2021. WC-21-27

Copyright: WCRI