North Carolina Faces High Hospital Costs for Injured Workers

Hospital costs per workers’ compensation claim in North Carolina remained higher than in most states in 2012 despite attempts to control them, according to the Workers Compensation Research Institute (WCRI).

WCRI’s report, “CompScope Medical Benchmarks for North Carolina, 15th Edition,” looked at medical costs between 2007 and 2012, a period that includes a 2009 reduction in the state’s hospital fee schedule for outpatient care. It compared results with those of 15 other states.

Overall, North Carolina’s medical payments per claim were typical, but there were differences by provider. The report said hospital costs per claim were among the highest of states WCRI studied. Nonhospital costs, on the other hand, were slightly lower than the typical state, driven by lower prices paid.

North Carolina tackled the issue of hospital costs in 2009 by reducing the hospital outpatient reimbursement rate to 79 percent of charges, down from 95 percent.

North Carolina enacted additional changes in 2013, freezing charges for inpatient and outpatient services, then cutting rates between 10 and 15 percent. Further, legislation passed in 2013 required hospital reimbursement to be based on methodologies used by Medicare, but no changes have been enacted yet.

WCRI, an independent research organization, said its study takes place mainly before the 2013 changes to hospital reimbursement could have had any effect. Researchers stated they observed an increase in prices paid for office visits and physical medicine services in 2013, following fee schedule changes which took effect Jan. 1, 2013.

Over time, though, medical payments per claim changed little from 2009 to 2012, as the number of visits per claim and the price paid for nonhospital care changed little, the report said.