Rebecca Yang analyzed the impact of the 2011 30% fee schedule reduction on prices paid for professional services in IL. Here are the highlights…
- WC prices paid (not billed, or Fed Schedule) for office visits were 18% lower than group health and 15% below Medicare.
- Costs for office visits went from 20% above the study state average to 20% below that average after reform.
- Surgery was a VERY different story; arthroscopic knee surgery costs were 166% higher than group health and 380%+/- above Medicare.
- Actual prices paid dropped after the reduction, but by 24%, not 30%. this was likely due to negotiations between the providers and network operators. In addition, some providers dropped out of networks, eliminating any discount below FS.
- It appears utilization may have increased, off-setting a third to a half of the impact of price reduction.