Illinois workers’ compensation medical fee schedule under scrutiny

In 2011, an across-the-board 30 percent cut was implemented in medical fee schedules for the Illinois workers’ compensation system. Some observers say that medical fees in the workers’ compensation system are now so low that doctors and other medical professionals may be reluctant to treat injured workers.

Doctors report that workers’ compensation payments are now lower than Medicare rates, which has an impact on access to medical care.

A study by the Workers Compensation Research Institute, a think tank funded by the insurance industry, found that prices for surgeries in the workers’ comp system remain high, while the cost of office visits may be too low.

The report claimed that if workers’ compensation prices are set below prices paid by group health insurers or Medicare, then injured workers may not have access to care. However, if prices are set higher than for other payors, then they could be lowered without affecting access to care.

The report also compared prices paid for nonhospital professional medical services and for group health prices and Medicare rates after the 2011 fee reduction. A significant difference between surgery costs and office visits was found.

The average workers’ compensation office visit cost for a condition of low or moderate severity was $62, $14 less than the estimated group health care plan price and $11 below the Medicare rate. Researchers said that policymakers should consider whether the lowered fee schedule may impair access to care.

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