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WCRI – impact of reform in Illinois

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.

One thought on “WCRI – impact of reform in Illinois”

  1. Workers compensation fee schedule drops in Maryland and DC have hit the radiology providers especially hard. Through my travels, I have been witnessing raiology poviders opting out of the traditional networks and choosing to take fee schedule instead. The networks are having to ask payers to accept charges above fee schedule to keep their services vaible. Many payers are refusing to pay more than required and are substituting lower price in place of value added services. This is an environment where technology solution companies can thrive and gain market share. One thing for sure the landscape in radiology is changing rapidly with quality providers choosing more and more to drop out of the traditional networks who have dominated the workers compensation market for the past three decades.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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