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North Carolina outpatient payments for injured workers stable – for now

March 13, 2013

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Cambridge, MA – Recent reforms to reduce outpatient hospital costs in North Carolina have stabilized payments for injured worker treatments, but growth could resume, according to a study from the Workers Compensation Research Institute.

Following a year in which payment per service increased 12 percent, North Carolina enacted reforms in 2009 that reduced the reimbursement rate for hospital outpatient services to 75 percent from 95 percent. From 2009 to 2010, the average hospital outpatient payment per service did not change, a WCRI press release states.

However, the average charge per service grew 11 percent in 2010, which could lead to the stability of payments becoming a one-time effect, according to the study.

“Charges increased at a rate much faster than cost-saving estimates anticipated,” WCRI counsel and Deputy Director Ramona Tanabe said in the press release. “Over time, this could affect the impact of the fee schedule reduction because a lower percentage of a higher charge would be less likely to achieve the state’s cost-savings goal.”

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