Texas Workers' Comp Medical Costs Highest

The average medical cost for workers' compensation claims in Texas\r\nare highest of the eight large states analyzed in a study by the\r\nWorkers Compensation Research Institute.

The average medical cost for workers'' compensation claims in Texas are highest of the eight large states analyzed in a new study by the Workers Compensation Research Institute (WCRI).

The higher cost per claim, among eight largely higher cost states, is the result of the state''s significantly higher medical utilization rate -- the number of services and visits to physicians, chiropractors, physical therapists and hospitals, said the study.

The study of eight states, California, Connecticut, Florida, Georgia, Massachusetts, Minnesota, Pennsylvania and Texas, represent 40 percent of the benefits paid in the nation''s workers'' compensation system.

"This reference work is designed to improve the decision making process of public officials and business people seeking to target cost drivers and benchmark system performance in Texas and other states," said Dr. Richard Victor, executive director of the Massachusetts-based WCRI. "We learned that if policymakers in Texas want to reduce its high medical costs, they must focus on the reasons behind the high use of medical services provided to injured workers."

The study found that the average medical cost per claim in Texas ($6,345) is nearly 36 percent higher than that in the median state studied ($4,671).

The typical number of visits per claim in Texas 23.8 versus the eight state median of 18.0 and the average number of services per claim -- 82.4 compared with the median of 55.7 -- are the highest of the states surveyed.

Although the utilization of services could be caused, in part, by differences in the severity of injuries, the study said it is likely that medical practice and billing patterns play a major role since the patterns are similar for lost-time claims of seven days or less in duration.

The study found both chiropractors and physical/occupational therapists are involved in a higher than typical percentage of cases in Texas.

For chiropractors the average number of visits per claim is almost double that of the median state studied, and the average payment per service is 34 percent higher.

For physical/occupational therapists, the number of visits per claim is average, but the payment per service is 24 percent higher than the median of the states surveyed.

"This may mean that these providers deliver more complex services, or it may simply mean that they are paid more for similar services," said Stacey Eccleston, senior analyst at WCRI and the study''s lead author.

Further contributing to the high utilization rate in Texas, the study reported that the number of office visits is more than twice as high as median states in the study.

The study also found that hospitals in Texas bill for office visits in fewer claims than do hospitals in the median state studied, but the costs of those visits is 32 percent higher.

by Virginia Sutcliffe

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