This 20th edition CompScope™ Medical Benchmarks study continues to monitor the effects of recent policy changes in North Carolina, particularly medical reimbursement rules that became effective in 2015. Those changes, along with interim fee schedule changes in 2013, targeted a key cost driver of workers’ compensation claims in North Carolina—hospital costs.

The 2015 medical fee schedule rules set reimbursement for medical care based on a percentage of Medicare. Phased-in decreases in reimbursement for hospitals and ambulatory surgery centers (ASCs) went into effect beginning in April 2015, while increases in reimbursement for nonhospital (professional) services became effective in July 2015. The medical data we report reflect those changes, up to 36 months of experience under the hospital and ASC fee schedules and up to 33 months of experience following implementation of the nonhospital fee schedule. Thus, the results we show reflect the majority of the impact of the fee schedule changes.

In this study, we examine medical payments per claim, prices, and utilization in North Carolina and compare them with 17 other states. We also examine how these metrics of medical costs and care have changed primarily from 2012 to 2017. We analyzed claims with experience through 2018 for injuries up to and including 2017. In some cases, we used a longer period to supply historical context for key metrics. 

CompScope™ Medical Benchmarks for North Carolina, 20th Edition. Carol A. Telles. October 2019. WC-19-38.

Copyright: WCRI