Rising hospital costs in the treatment of injured workers have received attention from public policymakers and system stakeholders in many states. To assist in better understanding these costs, this study compares hospital outpatient payments across states and monitors the impact of fee schedule reforms from 2005 to 2017. It also includes an additional benchmark comparing workers’ compensation hospital outpatient payments and Medicare rates.

These comparisons focus on the experience of states with different types of fee regulations. The analysis captures payments for services provided and billed by hospitals, and it excludes professional services billed by nonhospital medical providers (such as physicians, physical therapists, and chiropractors) and transactions for durable medical equipment and pharmaceuticals billed by providers other than hospitals. The analysis also excludes payments made to ambulatory surgery centers.

The 36 states included in this study are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.

Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 8th Edition. Olesya Fomenko and Rui Yang. May 2019. WC-19-24.

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