This study can help policymakers and other stakeholders in the workers’ compensation system to identify cost drivers and emerging trends in payments and utilization of medical services among nonhospital and hospital providers. In this report, we examine medical payments per claim, prices, and utilization in North Carolina and compare them with 17 other states.

The study also examines how these metrics of medical costs and care have changed, mainly from 2015 to 2020, for claims at an average of 12 months of experience. We analyze claims with experience through 2021 for injuries up to and including 2020. In some cases, we use a longer time frame to supply historical context.

The data in this report reflect the full effects from major changes in medical reimbursement rules that became effective in 2015, with reimbursement based on a percentage of Medicare. Therefore, we begin some of our trend analysis in 2014 to show the impact of those changes.

The results we report reflect experience on claims through March 2021, including non-COVID-19 claims only from the early pandemic period (March–September 2020). The study, therefore, provides a look at how the pandemic may have impacted non-COVID-19 workers’ compensation claims in the early months of the pandemic. 

CompScope™ Medical Benchmarks for North Carolina, 23rd Edition. Carol A. Telles. October 2022. WC-22-36.

Copyright: WCRI