Provider reimbursement is changing
boding ill for work comp.
The net - Medicare is cutting reimbursement for facility-based providers and services and docs doing procedures, while increasing reimbursement for primary care/E&M services.
Expect prices to increase for workers’ comp medical care…WC is much more exposed to facilities and procedures than other payers.
Physician payments
Big news you may have missed - CMS released physician fee schedules for 2026 - net is non-hospital physicians doing Evaluation and Management (E&M) work get a nice bump up, while docs doing procedures (surgeries, injections, imaging etc) get…squat.
Without getting too deep in the weeds, some of the factors evolved in setting reimbursement for proceduralists (my word) will be massaged so those MDs will actually see a small cut in reimbursement.
For you this means more incentive for facility-based provides to do more procedures - and more intensive ones - for any patients they treat.
Good news is there’s more focus on and compensation for behavioral health and primary care.
Medical inflation in work comp
graphic courtesy NCCI
The brainiacs at NCCI released an updated Medical Inflation Insights report; medical prices were up 2.5% through August of this year…a slower pace than the previous two years. Quick take…
physician prices were up 2.1%…
facility prices for outpatient care jumped much more - 3.8% over the last year
Speaking of physicians…
Another of WCRI’s highly informative webinars is on the schedule for Thursday November 20. Advanced Practitioners - Physicians’ Assistants, Nurse Practitioners and the like - are more prevalent in workers comp of late . WCRI will dive into any differences in outcomes, care patterns, referral patterns, disability durations and the like when Advanced practitioners are involved vs MDs.
What does this mean for you?
Good news for primary care, gotta love more $$ for prevention and behavioral health.
Higher costs for procedure and facility-based services.