This study examines medical payments per claim, prices, and utilization for various types of services by nonhospital and hospital providers in Texas, and compares them with 17 other states. It also examines how these metrics of medical costs and care have changed, mainly from 2014 to 2019, for claims at an average of 12 months of experience.

The data in this report likely reflect all effects from House Bill (HB) 7 provisions enacted beginning in 2006, including certified medical networks, the required use of treatment guidelines and utilization review, and the adoption of a drug formulary.

Claims with experience through 2020 for injuries up to and including 2019 were analyzed. In some cases, a longer time frame was used to supply historical context. Information from other WCRI studies was also included to provide a more complete picture of the system in Texas.

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 Texas, 22nd Edition. Carol A. Telles. October 2021. WC-21-37.

Copyright: WCRI