Fee Schedules Help Reduce Workers’ Comp Medical Costs in Illinois: Study

November 4, 2014

Reforms enacted in 2011 continue to drive down the cost of medical care for injured workers in Illinois, according to a new study by the Workers Compensation Research Institute (WCRI).

According to the report, CompScope Medical Benchmarks for Illinois, 15th Edition, medical payments per claim fell 20 percent between 2010 and 2012.

The decrease likely reflected the impact of a 30 percent reduction in fee schedule rates included in the reforms, effective for services provided after Sept. 1, 2011, according to WCRI.

The decrease in medical payments per-claim was the sharpest of the 16 states WCRI studied. Illinois medical payments per claim were closer to the median study state, where it had been among the highest of study states prior to the regulatory changes.

Medical payments per claim have two components: the price for each service provided and the number of services provided (utilization). In Illinois, prices paid for professional services decreased 27 percent between 2010 and 2012. Payments per service for hospital outpatient services decreased 16 percent. Utilization changed little, the report said.

In 2013, prices paid for professional services grew little, related to annual updates in the Consumer Price Index for Urban Consumers (CPI-U). The small increase is consistent with the design of the Illinois fee schedule to update fee schedule rates with the annual changes in CPI-U.

Other reforms passed in 2011 introduced preferred provider programs (PPPs) for selecting treating physicians. Utilization review, based upon recognized treatment guidelines and evidence-based medicine, was also required. The impact of these changes may be evident over the next several years, the study said.

Source: WCRI

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