Post on 22-Apr-2018
An In-Depth Look at Workers’ Compensation Medical Costs in Minnesota
Minnesota Workers’ Compensation Advisory CouncilMarch 12, 2014
▪ About WCRI
▪ Highlights from WCRI research relevant to Minnesota workers’ compensation medical costs
▪ Trends
▪ Interstate comparisons
▪ Longer-term opioid use
▪ Physician dispensing
Today’s Outline
2
1Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ Independent, not-for-profit research organization
▪ Mission: to be a catalyst for constructive improvements in workers’ compensation systems
▪ Diverse membership support (including Sentry)▪ Focus on benefit delivery system, not insurance market▪ Studies are peer-reviewed▪ Do not make recommendations or take positions
▪ Resource for public officials and stakeholders▪ Over 400 WC studies published
About WCRI
3© Copyright 2013 WCRI. All Rights Reserved.
WCRI Provides States With A Broad Scope Of Benchmarking Studies
4© Copyright 2014 WCRI. All Rights Reserved.
MN
CompScope™Worker
Outcomes
Longer-Term Use Of Opioids
MCCInventory
MedicalPrice IndexPhysician
Dispensing In WC
PrescriptionBenchmarks
HospitalCost Index
InterstateVariation In Use
Of Narcotics
Hospital/ASCFS Inventory
2Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
CompScope™CompScope™ Medical▪ Medical costs
▪ Medical prices
▪ Utilization of services
▪ By provider type
▪ By service type
Scope Of CompScope™ Multistate Benchmarks
▪ Benefit amounts
▪ Timeliness
▪ Medical costs
▪ Disability duration
▪ Defense attorney involvement
▪ Vocational rehabilitation use
▪ Benefit delivery expenses
5© Copyright 2014 WCRI. All Rights Reserved.
▪ Data reasonably representative of state experience▪ 51% of Minnesota claims; 36–69% across all 16 states
▪ Meaningful interstate comparisons▪ Definitions harmonized across states and data sources▪ Adjusted for differences in injury/industry mix▪ Adjusted for differences in waiting periods (claims with
> 7 days of lost time)▪ Trends shown are unadjusted numbers▪ Analysis focuses on cases with different maturities
(12, 24, and 36 months of experience) to capture phenomena that occur earlier and later in a claim
▪ See the Technical Appendix for more detail
Data And Methods In This Study
6© Copyright 2014 WCRI. All Rights Reserved.
3Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
▪ Little change in medical payments per claim since 2009▪ Slower growth in hospital outpatient payments/service reflects
slower growth in charges
▪ Nonhospital prices stabilized after 2010 fee schedule updates
▪ Overall nonhospital utilization stable
▪ Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
7© Copyright 2014 WCRI. All Rights Reserved.
Growth In Minnesota Medical Payments Generally Typical During 2006 To 2011
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
FL NC MI TX MA MN IL VA PA CA IA NJ AR WI LA IN
Annu
al A
vg. %
Cha
nge
In M
edic
al
Cos
ts/C
laim
(20
06
/07
To
201
1/1
2)
AAPC: 4.6%
Median AAPC: 5.6%
8© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
4Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Faster Growth In Payments For Hospital Inpatient Episodes During 2006 To 2011
Medical Cost Components (AAPC 2006/07 to 2011/12)
MinnesotaMedian State
Nonhospital Payments/Claim 4.5% 5.4%
Prices Paid 1.1% 1.8%
Utilization 1.6% 2.5%
Hospital Outpatient Payments/Claim 5.9% 6.0%
Payments/Service 3.9% 5.9%
Services/Claim 1.9% 0.7%
Hospital Payments/Inpatient Episode 7.8% 6.7%
Inpatient Surgical Episodes 9.5% 7.4%
Inpatient Nonsurgical Episodes 5.9% 6.4%
9© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time, Not Adjusted For Injury/Industry Mix
Rapid Increases In MN Hospital Inpatient Payments: Not A Recent Phenomenon
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Aver
age
Hos
pita
l Pay
men
ts
Inpatient Episode Surgical Episode Nonsurgical Episode
10© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
AAPC 2002 To 2011 2006 To 2011
Payments/Inpatient Ep. 7.3% 7.8%
Inpatient Surgical Ep. 8.5% 9.5%
Inpatient Nonsurgical Ep. 6.3% 5.9%
5Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Longer-Term Decline In % Of MN Claims With Inpatient Episodes, Esp. Surgical
0%
2%
4%
6%
8%
10%
12%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
% O
f Cla
ims
With
Inpa
tient
Epi
sode
s
All Inpatient Surgical Nonsurgical
11© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
Decline In % Of Inpatient Episodes With Surgery In Minnesota
0%
10%
20%
30%
40%
50%
60%
70%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
% O
f Inp
atie
nt E
piso
des
With
Sur
gery
12© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
6Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Shift From Inpatient To Outpatient Surgery For MN Disc Conditions
Change In Measures For Disc Conditions: 2006/07 To 2011/12
% With Inpatient Care -15 ppt
% With Surgery -9 ppt
% With Inpatient Surgery -32 ppt
% With Outpatient Surgery 32 ppt
AAPC
Total Payments/Episode – Inpatient Surgery 8.8%
Total Payments/Episode – Outpatient Surgery 5.2%
Total Hosp. Payments/Episode – Inpatient Surgery 11.1%
Total Hosp. Payment/Episode – Outpatient Surgery 9.3%
13© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
Little change in medical payments per claim since 2009▪ Slower growth in hospital outpatient payments/service reflects
slower growth in charges
▪ Nonhospital prices stabilized after 2010 fee schedule updates
▪ Overall nonhospital utilization stable
▪ Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
14© Copyright 2014 WCRI. All Rights Reserved.
7Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Little Change In Minnesota Medical Payments Since 2009
-4%
-2%
0%
2%
4%
6%
8%
10%
12%
06/07 To07/08
07/08 To08/09
08/09 To09/10
09/10 To10/11
10/11 To11/12
Annu
al %
Cha
nge
In M
edic
al
Cos
ts/C
laim
Minnesota Median State
MN AAPC 2009 To 2011: -0.7%
MN AAPC 2006 To 2009: 8.3%
15© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
Little Recent Change In Nonhospital And Hospital Payments; Inpatient Increased
80
90
100
110
120
130
140
150
160
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Aver
age
Med
ical
Pay
men
t/C
laim
In
dexe
d To
20
06
/07
= 1
00
Nonhospital Hospital Hosp. Outpatient Hosp. Inpatient Episode
AAPC 2006 To 2009
Nonhospital: 7%
Hospital: 8%
Hospital Outpatient: 10%
Hospital Inpatient: 7%
16© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
AAPC 2009 To 2011
Nonhospital: 1%
Hospital: 3%
Hospital Outpatient: 0%
Hospital Inpatient: 9%
8Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Little Change In Most Medical Cost Components Since 2009, Except Inpatient
Annual Change In Medical Cost Components (AAPC)
2006/07 To 2009/10
2009/10 To 2011/12
Nonhospital Payments/Claim 7.1% 0.6%
Prices Paid 2.3% -0.7%
Utilization 3.1% -0.6%
Hospital Outpatient Payments/Claim 9.7% 0.4%
Payments/Service 7.6% -1.4%
Services/Claim 2.0% 1.9%
Hospital Payments/Inpatient Episode 7.2% 8.7%
17© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
▪ Little change in medical payments per claim since 2009Slower growth in hospital outpatient payments/service reflects
slower growth in charges
▪ Nonhospital prices stabilized after 2010 fee schedule updates
▪ Overall nonhospital utilization stable
▪ Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
18© Copyright 2014 WCRI. All Rights Reserved.
9Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Hospital Outpatient Services
Annual Average Change In Medical Payments Per Claim
2006/07 To 2009/10
2009/10 To 2011/12
Treatment/Operating/Recovery 15% 2%
Minor Radiology 11% -3%
Clinic/Evaluation & Management
4% 3%
Physical Medicine 8% 3%
Major Radiology 3% 0%
19© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
Slower Growth Since 2009 In Payments Per Claim For Most Hospital Outpatient Services
Payments/Service Key Driver Of Slower Growth In Hospital Outpatient Payments
Hospital Outpatient Services
Payments/Service(AAPC)
Services/Claim(AAPC)
06/07 To 09/10
09/10 To 11/12
06/07 To 09/10
09/10 To 11/12
Treat./Oper./Rec. 15% 2% 0% 0%
Minor Radiology 7% -1% 4% -2%
Clinic/Eval. & Mgmt. 3% 4% 1% -1%
Physical Medicine 6% 1% 2% 3%
Major Radiology 0% 1% 3% -1%
20© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
10Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ If more than 100 beds, reimbursement is limited to the lowest of:
▪ Maximum fee that applies to any service included in relative value fee schedule (typically labs, X rays, physical/occupational therapy)
▪ 85% of usual and customary charge
▪ 85% of the prevailing charge
▪ The facility’s actual charge
▪ If fewer than 100 beds, reimbursed at 100% of usual and customary unless judge decides fee is excessive
MN Reimbursement Approach: Changes In Payments Per Service Tied To Charges
21© Copyright 2014 WCRI. All Rights Reserved.
Hospital Outpatient Payments/Service Generally Tracked Growth In Charges…
75
100
125
150
175
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Inde
xed
To 2
00
6/0
7 =
10
0
TOR Charges Per Service TOR Payments Per ServiceOverall Charges Per Service Overall Payments Per Service
22© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
11Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
…Due Primarily To Slower Growth In Payments/Service Relative To Charges
Hospital Outpatient Services
2006/07 To 2009/10
(AAPC)
2009/10 To 2010/11
(% change)
2010/11 To 2011/12
(% change)
Change In Overall Charges/Service
7.7% 3.7% -1.4%
Change In Overall Payments/Service
7.3% 2.7% -6.0%
Change In TOR Charges/Service
13.3% 8.0% 9.0%
Change In TOR Payments/Service
12.7% 5.5% 2.2%
23© Copyright 2014 WCRI. All Rights Reserved.
Hospital Outpatient Services, Claims With > 7 Days Of Lost Time, Not Adjusted For Injury/Industry Mix
▪ Increase in use of networks among hospital providers
▪ Potential for discounts in payments relative to charges for payors using network
▪ More aggressive use of bill review services, including greater reliance on prevailing charge criteria to set maximum fees for large hospitals
▪ Increased use of Minnesota Department of Labor and Industry administrative processes for resolving disputes about medical fees
Possible Reasons For Recent Decrease In MN Outpatient Paid-To-Charge Ratios
24© Copyright 2014 WCRI. All Rights Reserved.
12Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Increase Since 2006 In Percentage Of Network Payments For Hospital Providers
57%
66% 67% 67% 68% 68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Perc
enta
ge O
f Pay
men
ts F
rom
N
etw
ork
Pro
vide
rs
Nonhospital Hospital
25© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
▪ Little change in medical payments per claim since 2009▪ Slower growth in hospital outpatient payments/service reflects
slower growth in charges
Nonhospital prices stabilized after 2010 fee schedule updates
▪ Overall nonhospital utilization stable
▪ Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
26© Copyright 2014 WCRI. All Rights Reserved.
13Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Overall Nonhospital Prices Stable After 2010 Fee Schedule Changes
75
100
125
150
175
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*
Pric
es P
aid
For P
rofe
ssio
nal S
ervi
ces
Inde
xed
To 2
00
2 =
10
0
Fee Schedule Change
27© Copyright 2014 WCRI. All Rights Reserved.
MN 2010 Fee Schedule Change Effective 10/1/10: Use 2009 Medicare RVUs To Replace 1998 RVUs; Decrease Conversion Factors To Hold Total Payments Constant. Source: WCRI Medical Price Index For WC, Fifth Edition (2013)
* Data shown for 2012 are based on data through June 2012.
Prices For Specific Services Stable After One-Time Fee Schedule Adjustments
75
100
125
150
175
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*
Inde
xed
To 2
00
2 =
10
0
E&M Physical Medicine Major RadiologyMinor Radiology Major Surgery Pain Mgmt. Inj.
Prices Stable
Fee Schedule Change
28© Copyright 2014 WCRI. All Rights Reserved.
MN 2010 Fee Schedule Change: Use 2009 Medicare RVUs To Replace 1998 RVUs; Decrease Conversion Factors To Hold Total Payments Constant. Source: WCRI Medical Price Index For WC, Fifth Edition (2013)
* Data shown for 2012 are based on data through June 2012.
14Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
▪ Little change in medical payments per claim since 2009▪ Slower growth in hospital outpatient payments/service reflects
slower growth in charges
▪ Nonhospital prices stabilized after 2010 fee schedule updates
Overall nonhospital utilization stable
▪ Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
29© Copyright 2014 WCRI. All Rights Reserved.
Overall Utilization In Minnesota Generally Stable Since 2009
30© Copyright 2014 WCRI. All Rights Reserved.
Claims With > 7 Days Of Lost Time, Not Adjusted For Injury/Industry Mix
Change In Utilization2006 /07 To
2009/102009/10 To
2010/112010/11 To
2011/12
Overall 3% -3% 2%
Evaluation & Mgmt. 3% -1% 0%
Major Radiology 0% -1% 1%
Minor Radiology 2% -2% 5%
Neuro. Testing 1% -6% -1%
Pain Mgmt. Injections -3% -2% -3%
Physical Medicine 2% -3% -1%
Major Surgery 3% -3% 7%
15Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ Overall medical cost growth generally typical, but faster growth in costs for hospital inpatient surgical episodes
▪ Little change in medical payments per claim since 2009▪ Slower growth in hospital outpatient payments/service reflects
slower growth in charges
▪ Nonhospital prices stabilized after 2010 fee schedule updates
▪ Overall nonhospital utilization stable
Overall medical payments per claim typical due to offsetting components, esp. for nonhospital providers
Key Findings For MN From CompScope™Medical Benchmarks, 14th Edition
31© Copyright 2014 WCRI. All Rights Reserved.
Minnesota Medical Payments Per Claim Typical Of 16 Study States
$0
$5,000
$10,000
$15,000
$20,000
MA CA MI TX MN AR FL PA NC LA NJ IA VA IL WI IN
Aver
age
Med
ical
Pay
men
t/C
laim
$11,070
Median: $11,993
32© Copyright 2014 WCRI. All Rights Reserved.
2011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
16Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Nonhospital Medical Payments Per Claim Lower; Typical For Hospitals
Payments Per Claim By Provider
MNMedian State
% Diff. Diff.
Nonhospital $5,511 $6,440 -14% Lower
Hospital $9,019 $9,238 -2% Typical
Hospital Outpatient $5,294 $5,252 1% Typical
Hospital Payment Per Inpatient Episode (2010/12)
$29,359 $29,043 1% Typical
33© Copyright 2014 WCRI. All Rights Reserved.
2011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
Prices Paid Typical To Higher For Many Nonhospital Services, Esp. Office Visits
84 85
100 104
118 119129
0
20
40
60
80
100
120
140
MajorSurgery
PainMgmt. Inj.
MinorRadiology
PhysicalMedicine
Neuro.Testing
MajorRadiology
Eval. &Mgmt.
Pric
es P
aid
(Med
ian
Sta
te =
10
0)
34© Copyright 2014 WCRI. All Rights Reserved.
Price Indices For Selected Nonhospital Services Rendered In 2011Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
17Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
77
89
91 94 98 100 101
0
20
40
60
80
100
120
PhysicalMedicine
Eval. &Mgmt.
MinorRadiology
Neuro.Testing
MajorSurgery
PainMgmt. Inj.
MajorRadiology
Util
izat
ion
(Med
ian
Sta
te =
10
0)
35© Copyright 2014 WCRI. All Rights Reserved.
Utilization Indices For Selected Nonhospital Services, 2011/122011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
MN Utilization Typical; Except Lower For Physical Medicine And Office Visits
Minnesota Hospital Payments Per Claim Typical Of 16 Study States
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
MA CA MI TX PA AR NJ MN FL IL LA IA VA NC WI IN
Aver
age
Hos
pita
l Pay
men
t/C
laim
$9,019
36© Copyright 2014 WCRI. All Rights Reserved.
2011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
Median: $9,238
No Hospital Fee Regulation
18Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Larger-Than-Typical Share Of Medical Payments To Hospital Providers
37© Copyright 2014 WCRI. All Rights Reserved.
2011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
0%
10%
20%
30%
40%
50%
60%
CA TX NJ IL FL MI MA WI LA PA IN AR VA MN NC IA
% O
f Med
ical
Pay
men
ts T
oH
ospi
tal P
rovi
ders
53%Median: 47%
MN Hospital Outpatient Payments Per Claim Typical Of 16 Study States
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
CA MA TX MI PA NJ AR FL MN VA IL NC IA IN WI LA
Aver
age
Hos
pita
l Out
patie
nt
Paym
ent/
Cla
im
38© Copyright 2014 WCRI. All Rights Reserved.
2011/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
Median: $5,252
$5,294
No WC Hospital Outpatient Fee Regulation
19Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
States With No FS Or % Charges (Like MN): Higher Outpatient Costs/Surgical Episode
39© Copyright 2014 WCRI. All Rights Reserved.
Hospital Outpatient Surgical Episodes, 2010Source: Hospital Outpatient Cost Index For Workers’ Compensation, 2nd Edition (2013)
0
20
40
60
80
100
120
140
160
MA OK MD PA MI CA TN TX GA NJ CT IA NC MN LA IN FL WI VA IL
Hos
pita
l Cos
t Ind
ex F
or S
urgi
cal
Epis
odes
(20
-Sta
te M
edia
n =
10
0)
No FS %-Of-Charge-Based Regulation “Fixed Amount” FS Other
Minnesota Had A Higher Percentage Of Claims With Inpatient Episodes
0%
2%
4%
6%
8%
10%
12%
WI CA MA IN FL NC TX IL MI IA PA NJ MN VA LA AR
% O
f Cla
ims
With
Inpa
tient
Epi
sode
s
Median: 7.8%
40© Copyright 2014 WCRI. All Rights Reserved.
2010/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
9.6%
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A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Minnesota Among States With Higher % Of Inpatient Episodes With Surgery
0%
10%
20%
30%
40%
50%
60%
FL TX IN CA LA MA IA NJ NC AR PA WI MI VA IL MN% O
f Inp
atie
nt E
piso
des
With
Sur
gery
Median: 49%
41© Copyright 2014 WCRI. All Rights Reserved.
2010/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
60%
MN Hospital Payments Per Inpatient Episode Typical Of 16 Study States
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
MI MA TX LA CA FL WI PA AR IA MN NJ IN NC VA IL
Aver
age
Hos
pita
l Pay
men
t/In
patie
nt E
piso
de
Median: $29,043
42© Copyright 2014 WCRI. All Rights Reserved.
2010/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
$29,359
No Hospital Inpatient Fee Regulation
21Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
MN Hospital Payments Per Inpatient Surgical Episode Typical
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
MI MA LA TX CA AR PA MN FL WI NJ IA VA NC IL INAver
age
Hos
pita
l Pay
men
t/In
patie
nt
Sur
gica
l Epi
sode
Median: $34,137
43© Copyright 2014 WCRI. All Rights Reserved.
2010/12 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix
$32,373
No Hospital Inpatient Fee Regulation
▪ Minnesota had lower prevalence of longer-term opioid use among injured workers
▪ Generally low frequency of recommended urine drug testing, psychological evaluation, and psychological treatment/reports across states, including Minnesota
▪ Prevalence of physician dispensing in Minnesota lower than typical compared with other study states
▪ Due to statutory provisions
Other Key Findings For Minnesota
44© Copyright 2014 WCRI. All Rights Reserved.
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A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Most Injured Workers With Pain Medications Received Opioids
0%
25%
50%
75%
100%
CT NJ IL MI CA PA GA NY MA IA IN VA SC AZ TX* WI MN TN LA NC AR
% O
f Cla
ims
With
Pai
n M
edic
atio
ns T
hat H
ad O
pioi
d R
x
45© Copyright 2013 WCRI. All Rights Reserved.
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2008 To September 2009, Prescriptions Filled Through March 2011. Source: Longer-Term Use of Opioids (2012)
* Texas Closed Formulary Went Into Effect On September 1, 2011, Which Was Expected To Reduce Use And Longer-Term Use Of Opioids
Longer-Term Use Of Opioids Less Prevalent In Minnesota
0%
5%
10%
15%
20%
AZ WI NJ IN IA MN AR MI IL MA GA TN VA CT NC CA SC PATX*NY LA
% O
f Non
surg
ical
Cla
ims
With
O
pioi
ds T
hat W
ere
Iden
tifie
d As
Lo
nger
-Ter
m U
sers
Of O
pioi
ds
46© Copyright 2013 WCRI. All Rights Reserved.
Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2008 To September 2009, Narcotic Prescriptions Filled Through March 2011 . Source: Longer-Term Use of Opioids (2012)
* Texas Closed Formulary Went Into Effect On September 1, 2011, Which Was Expected To Reduce Use And Longer-Term Use Of Opioids
23Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Frequency Of Drug Testing Was Low, Even After Considerable Increases
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Longer-Term Users Of Opioids, Injury Years 2007 & 2009, Average 24-Month Snapshots. Source: Longer-Term Use of Opioids (2012)
% Of Claims With Longer-Term Use Of Opioids That Received Urine Drug Testing
21-State Median
MN
2007/2009 14% 5%
2009/2011 24% 15%
47© Copyright 2013 WCRI. All Rights Reserved.
Nonsurgical Claims With > 7 Days Of Lost Time That Were Identified As Longer-Term Users Of Opioids, Injury Year 2009, Prescriptions Filled Through March 2011, Average 24-Month Snapshots. Source: Longer-Term Use of Opioids (2012)
Psychological Evaluations And Treatment Performed Infrequently
% Of Claims With Longer-Term Use Of Opioids That Received…
21-State Median
MN
Psychological Evaluations
2009/2011 7% 7%
Psychological Treatment
2009/2011 4% 4%
48© Copyright 2013 WCRI. All Rights Reserved.
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A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
Much Lower Percentage Of Prescriptions Were Dispensed By Physicians In MN
0%
10%
20%
30%
40%
50%
60%
MA
NY TX AR MN LA VA NC WI
KS IA
SC
* NJ
TN*
MO PA MI*
IN*
GA* CT* MD
IL*
FL*
CA*%
Of A
ll R
x Fo
r Ph
ysic
ian-
Dis
pens
ed R
x
49
In MA, NY, & TX, Physician Dispensing Not Allowed In General; Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time. Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013)
* States With Reforms Aimed At Reducing Prices Paid For Physician-Dispensed Rx
© Copyright 2014 WCRI. All Rights Reserved.
Minnesota Among Lowest Of Study States In Physicians’ Share Of Rx Costs
0%
10%
20%
30%
40%
50%
60%
MA
NY TX AR MN NJ
VA KS IA NC WI
IN* LA MO
MI*
SC
*
TN*
GA* PA CT*
CA* MD
FL*
IL*
50
In MA, NY, & TX, Physician Dispensing Not Allowed In General; Prescriptions For 2011/12 Claims With > 7 Days Of Lost Time. Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013)
% O
f Rx
Paym
ents
For
Phy
sici
an-
Dis
pens
ed R
x
* States With Reforms Aimed At Reducing Prices Paid For Physician-Dispensed Rx
© Copyright 2014 WCRI. All Rights Reserved.
25Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4
▪ Benchmarks for Minnesota, CompScope™ 14th Edition (2013)▪ Medical Benchmarks for Minnesota, CompScope™ 13th Edition (2013)▪ WCRI Medical Price Index, Fifth Edition (2013)▪ Hospital Outpatient Cost Index for WC (2013)▪ The Prevalence and Costs of Physician-Dispensed Drugs (2013)▪ Workers’ Compensation MCC: National Inventory, 2013 (2013)▪ Longer-Term Use of Opioids (2012)▪ Designing WC Medical Fee Schedules (2012)▪ Workers’ Compensation Laws (2012) ▪ Interstate Variations in Use of Narcotics (2011)▪ Prescription Benchmarks, 2nd Edition: Trends and Interstate Comparisons
(2011)▪ National Inventory of WC Fee Schedules for Hospitals and Ambulatory Surgical
Centers (2010)
Other WCRI Studies Of Interest For Minnesota
51© Copyright 2014 WCRI. All Rights Reserved.
Sharon Belton Senior Public Policy Analyst
sbelton@wcrinet.org715.302.8483
orRamona Tanabe
Deputy Director and CompScope™ Program Manager
rtanabe@wcrinet.org617.661.9274
Please Direct Questions And Comments About WCRI Findings To:
52© Copyright 2014 WCRI. All Rights Reserved.
26Copyrighted: Do not distribute without WCRI’s written consent
A N I N - D E P T H L O O K A T W O R K E R S ' C O M P E N S A T I O N M E D I C A L C O S T S I N M I N N E S O T A P R E S E N T A T I O N B Y W C R I - 3 / 1 2 / 2 0 1 4