In this study, we examine medical payments per claim, prices, and utilization in North Carolina and compare them with 17 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin). We also examine how these metrics of medical costs and care have changed primarily from 2011 to 2016. Claims with experience through 2017 for injuries up to and including 2016 were analyzed. In some cases, we used a longer time frame to supply historical context for key metrics.

Policy changes in recent years have targeted a key cost driver of workers’ compensation claims in North Carolina—hospital costs. Interim fee schedule changes went into effect in 2013, with the goal of reducing payments for hospital care while increasing prices paid for office visits and physical medicine services. New fee schedule rules became effective in 2015, with reimbursement based on a percentage of Medicare, as required under House Bill 92, which was passed in July 2013. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect in April 2015, while changes in reimbursement for nonhospital (professional) services became effective in July 2015.

Those changes are partly reflected in the medical data we report, with up to 24 months of experience under the hospital and ASC fee schedules and up to 21 months of experience following implementation of the nonhospital fee schedule. Thus, this study provides an early look at the effects of the 2015 changes in reimbursement for medical care. The next edition of this study will reflect experience following implementation of all three phases of the hospital and ASC fee schedule changes. Future editions will monitor the longer-term effects of the new fee schedule rules. 

CompScope™ Medical Benchmarks for North Carolina, 19th Edition. Carol A. Telles. October 2018. WC-18-34.

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