Workers’ compensation pays more than group health to treat similar injuries, according to a research report by the National Council for Compensation Insurance.
Although the employee compensation benefit system is specifically tailored to the needs of employers and injured workers, it works within a much larger health care system, the NCCI explained in the letter.
Although group health (GH) is a far larger part of this system than employee compensation insurance (WC), the two types of coverage have much in common in the medical services they cover, which is why it “makes sense to use group health data”. to compare prices and usage between the two, ”reads the briefing written by Dan Corro, Tom Daley and Barry Lipton.
Main findings of the report
For 12 common occupational injuries, the costs for medical services within the WC and GH insurance systems show the following:
- WC pays more than GH to treat similar injuries
- The clearest difference between WC and GH is the greater number of physical medical services in WC
- The usage differences are much larger than the price differences for toilet versus GH, which explains most of the cost difference
- The differences in usage vary mainly according to the type of injury: All selected injuries show a higher utilization for WC than for GH
- Price differences are more related to jurisdiction than type of violation for toilet, in part due to different state fee schedules
- Differences in costs between countries correlate more strongly with differences in price than with differences in use
- Traumas to arms and legs consistently show smaller differences in costs and use of the toilet, while chronic pain-related injuries such as bursitis and back pain show greater differences
- A more expensive mix of procedures for complex toilet cases contributes to higher costs compared to GH, especially for referral-based care such as radiology and surgery.
The toilet experience for this study comes from the Medical Data Call (MDC) of the NCCI. The MDC collects transaction-level details of medical bills processed on or after July 1, 2010. These details include data from services, fees, payments, procedural codes, and diagnostic codes. NCCI collects the data and manages the tender for 35 jurisdictions in which NCCI provides rate discovery services and for several other states.
The GH data for this study is based on medical experience from employer-funded health insurance plans. NCCI licensed it from Truven Health Analytics, an IBM Watson Health Co. that provides health data and analysis.
Both the WC and the GH data refer to the years of service from 2013 to 2016. To be comparable to WC, the GH payments reflect the full cost of each service, including any co-payments, deductibles or co-insurance. Crucial to the study is that both WC and GH use CPT codes to identify medical procedures and ICD diagnostic codes. (Publisher’s Note: In the footnotes of the report, CPT codes are defined as “Current Procedural Terminology,” which is a standard coding scheme in medical billing used to identify specific procedures. ICD refers to the “International Classification of Diseases,” which is also a standard coding scheme in medical billing.)
The full report is entitled: “Workers Compensation and Group Health – Comparing the Use of Medical Services”.
Source: National Council for Compensation Insurance
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