Indiana workers’ average medical payment per claim inches up
WCRI report: Hospital payments jumped 4% during the study period.
The average medical payment per claim of Indiana workers is rising, according to a recent report by the Workers Compensation Research Institute (WCRI).
The average payment increase, based on claims data between 2017 and 2022 with claims experience through March 2023, is due to nonhospital services costs, ambulatory surgery centers (ASCs), fluctuations in hospital payments and utilization decreases, the data showed.
“Indiana has no fee schedule for professional services like it does for hospitals, which means the state does not regulate prices for professional services or ASCs,” said Sebastian Negrusa, WCRI’s vice president of research. “The state did recently implement a fee schedule for ASCs, effective January 2023. Time will tell what effect that will have.”
Hospital payments per inpatient episode jumped 4% during the study period, with high-cost episodes making-up the top 20% and representing roughly 50% of all inpatient payments in Indiana, according to the WCRI.
At the same time, the percentage of claims with major surgery decreased from 42% to 37% during the period.
Other key findings from the WCRI report include:
- Prices paid for professional services remained stable in contrast to most other non-fee schedule study states and were largely in the middle of that group (Indiana, Iowa, New Hampshire, New Jersey, Missouri, and Wisconsin).
- While the share of physician payments in networks decreased in most study states, there was little change in Indiana.
- From 2005 to 2022, Indiana had a long-term decrease in the share of hospital outpatient claims. This was a 4% decrease in utilization from 2005 to 2019, and a 6% decrease from 2019 to 2023. During this time, however, payments per claim for those services increased.
Meanwhile, medical claims for Indiana workers are predicted to rise with winter on the way. Employees file 10% more workers’ compensation claims on cold days as both motor and cognitive performance degrades under these conditions. The negative effects of poor outdoor weather also impact indoor tasks.
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