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 16 other states.

The study also examines how these metrics of medical costs and care have changed, mainly from 2016 to 2021. We analyze claims with experience through 2022 for injuries up to and including 2021. 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 rates. Therefore, we begin some of our trend analysis in 2014 to show the impact of those changes.

The results we report include non-COVID-19 claims from the first and second years of the COVID-19 pandemic (March 2020 through September 2021). The study, therefore, provides insights into how the pandemic likely impacted non-COVID-19 workers’ compensation claims in the first two years of the pandemic.

CompScope™ Medical Benchmarks for North Carolina, 24th Edition. Carol A. Telles. October 2023. WC-23-43.

Copyright: WCRI