WCRI: Medical Payments Decreased in Half the Study States in 2020, Due to COVID-19

Cambridge,MA(WorkersCompensation.com) ― Medical payments per claim decreased more than 3 percent in half the 18 study states for 2020 injuries with experience through March 2021, according to a new set of studies by the Workers Compensation Research Institute (WCRI). This likely reflects factors related to the COVID-19 pandemic. Over the earlier period from 2015 to 2019, medical payments per claim were stable or grew moderately across the study states.

“Temporary suspensions of nonemergency treatment and procedures, avoidance of care because of concerns about contracting COVID-19, and increases in the use of telehealth services contributed to changes in medical payments and utilization,” said Ramona Tanabe, executive vice president and counsel for WCRI. “In addition, other factors — such as the timing and severity of the pandemic, the speed of resuming nonemergency surgeries and procedures, the degree of reliance on hospital care, and state policies — influenced the differences in medical trends across states.”

The following are sample findings for some of the study states:

• Florida: Medical payments per claim in Florida decreased 5 percent in 2020/2021 (claims with injuries from September 2019 to October 2020 and experience through March 2021) for non-COVID-19 claims, mainly driven by a decrease in utilization of medical services, following 4–5 percent per year growth from 2015 to 2019.
• Indiana: Medical payments per claim in Indiana decreased 14 percent in 2020/2021 for non-COVID-19 claims after growing 11 percent in 2019.
• Michigan: Medical payments per claim in Michigan decreased 4 percent in 2020/2021 for non-COVID-19 claims, following increases of 4 percent per year from 2015/2016 to 2019/2020.
• Minnesota: Medical payments per claim in Minnesota experienced little growth from 2015 to 2018 and a slight decrease in 2019 following the adoption of Medicare-based fee schedules. In 2020/2021, this measure declined 5 percent for non-COVID-19 claims, mainly due to a decrease in utilization of medical services.
• Pennsylvania: Medical payments per claim in Pennsylvania decreased 5 percent in 2020/2021 for non-COVID-19 claims, following moderate growth of 4–5 percent from 2017 to 2019.

The studies, CompScope™ Medical Benchmarks, 23rd Edition, provide analyses of recent cost drivers and trends for policymakers and other system stakeholders, reporting how medical payments per claim and cost components vary over time and from state to state. The reports identify where medical cost and care patterns may be changing and where medical payments per claim or utilization may differ from other states. The studies cover the period from 2015 through 2020, with claims experience through March 2021, including non-COVID-19 claims only from the early pandemic period (March–September 2020). They, therefore, provide a look at how the pandemic may have impacted non-COVID-19 workers’ compensation claims in the early months of the pandemic.

The 18 states in the study ― Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin ― represent more than 60 percent of the nation’s workers’ compensation benefit payments. Individual reports are available for every state except Arkansas, Georgia, Iowa, and Tennessee.

For more information on these studies, visit https://www.wcrinet.org.

About WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.