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Delaware workers' comp. fee schedule rates for ASC services were 91%-144% above Medicare for knee, shoulder procedures following legislative changes

Workers Compensation Research Institute published a report analyzing whether Delaware's fee schedule changes lowered medicals expense across various sites, including ASC facility fees for surgical procedures.

House Bill 373 proposed a fee schedule change with the overall aim of truncating medical expenses by 33 percent by Jan. 31, 2017. The schedule had three consecutive annual reductions — a 20 percent reduction in 2015 and additional 5 percent and 8 percent reductions in 2016 and 2017, respectively.

Starting January 31, 2015, the state moved to Medicare-based fee schedules for ASCs, professional services, hospital inpatient and outpatient services.

Here's what the report found:

1. Compared to the 32 states the report analyzed, Delaware ASCs fell slightly below the middle regarding facility payments for the most common knee arthroscopy in 2015, prior to the legislative change.

2. Delaware ASC facility workers' compensation fee schedule rates were set between 91 percent and 144 percent above Medicare for common knee and shoulder surgeries this year, illustrating the impact of the House Bill 373's fee schedule change.

3. In 2017, workers' compensation fee schedule rates for Delaware hospital outpatient services fell between 40 percent and 72 percent above Medicare for common knee and shoulder surgeries.

WCRI President and CEO John Ruser said, "In many states, policymakers and other stakeholders are looking to fee schedules to help control the growth of medical care costs in their workers' compensation systems while avoiding access-to-care issues. Our research helps these decision makers learn if the reforms they passed are having the impact they intended or need to be modified."

For more on the report's findings, click here

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