Delaware Fee Schedule Changes Examined In New WCRI Study

Our research helps these decision makers learn if the reforms they passed are having the impact they intended or need to be modified.

A new report from the Workers Compensation Research Institute (WCRI), Evaluation of the 2015, 2016, and 2017 Fee Schedule Changes in Delaware, provides policymakers and other stakeholders with the ability to examine all three rounds of the Delaware fee schedule changes enacted in House Bill (HB) 373.

“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,” said John Ruser, president and CEO of WCRI. “Our research helps these decision makers learn if the reforms they passed are having the impact they intended or need to be modified.”

The objective of the fee schedule changes in HB 373 was to reduce medical expenses by 33 percent by January 31, 2017, over three consecutive annual reductions—a 20 percent reduction in 2015 and additional 5 and 8 percent reductions in 2016 and 2017, respectively. Per HB 373, Delaware transitioned to Medicare-based fee schedules for professional services, hospital inpatient and outpatient services, and ambulatory surgery center (ASC) services effective January 31, 2015.

The medical services covered in the analysis are professional medical services, hospital outpatient and ASC facility services related to surgical procedures, and hospital inpatient services. For all of these services, the study monitors workers’ compensation fee schedule changes over three years and offers a comparison between the workers’ compensation fee schedule rates and Medicare rates in Delaware. For professional services, the analysis also includes an evaluation of the impact on prices paid as a result of the 2015 and 2016 changes. Also examined is the impact of these changes on interstate rankings of Delaware for professional services, hospital outpatient services, and ASC services.

The following are among the study’s major findings:

  • Before the 2015 change, Delaware had the second highest overall fee schedule rate for professional services relative to Medicare (123 percent above Medicare) among 44 jurisdictions with…

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