Comp Treatment Costs Higher Than In Group Health, Says NCCI

Workers’ compensation systems pay higher prices to treat worker injuries than group health plans for the same ailments, according to a new study of comp fee schedules by the National Council on Compensation Insurance.

Among other discoveries, the study found that comp systems pay more than group health for specific services, which are used more often in comp than in group health in an attempt to get an injured worker back on the job as quickly as possible.

Care that physicians provide at hospitals and other facilities was found more likely to exceed workers’ comp fee schedules than care provided in their offices. NCCI said that this was partly due to the fact that the fee schedule need not always apply when facilities bill for such services.

NCCI reported that the comp rates were particularly higher than group health for specialty areas such as radiology and surgery.

The organization said that advocates of higher comp fee schedules argue that if they are too low, worker access to care will be compromised. Additionally, NCCI said that comp claims require an investment in more costly paperwork.

Further, the group suggested that rural areas may have a limited number of medical specialists.

NCCI’s study reported a shift to a greater proportion of medical services being provided by hospitals and other facilities and a lower proportion by private physicians. It also found that the higher prices paid by workers’ comp are associated with higher utilization of services.

The researchers wrote that higher reimbursements are a financial incentive to medical providers to perform more procedures on comp claimants, while comp insurers are more willing to pay premium prices for care most necessary to result in a patient going back to work.

They said the more frequently used procedures are the most likely to be lobbied for higher fee schedule reimbursement.