Workers’ Compensation 

Research
▪ Independent, not-for-profit research organization

▪ Founded in Cambridge MA in 1983

▪ Diverse membership support

▪ Studies are peer-reviewed

▪ Resource for public officials & stakeholders

▪ Content-rich website: www.wcrinet.org

▪ Over 500 WC studies published

About WCRI

© Copyright 2015 WCRI. All Rights Reserved. 2
▪ Mission

“Be a catalyst for improving WC systems by providing the public

 with high-quality, credible information on important public

 policy issues.”

▪ Studies focus on benefit delivery system

▪ Does not make recommendations nor take positions 

on issues

WCRI Approach

© Copyright 2015 WCRI. All Rights Reserved. 3
▪ How states compare 

▪ Income benefit payments

▪ Worker outcomes

▪ Medical costs and care delivered

▪ Long-term opioid use

▪ Physician dispensing of Rx

▪ Trust in the workplace and worker outcomes

▪ Provider responses to medical price regulation

Outline: 

Illustrations Of Available Information

© Copyright 2015 WCRI. All Rights Reserved. 4
Wisconsin Indemnity Payments/Claim 

39% Lower Than The Median State

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

IN TX WI NJ FL AR MI MN VA MA CA IL IA PA LA GA NC

Average Indemnity Payment/Claim 

$10,847

Median State: $17,670

© Copyright 2015 WCRI. All Rights Reserved. 5

2011/14 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix And Wages; Source: 

CompScopeTM Benchmarks For Wisconsin, 15th Edition (2015).
WI Workers Achieve Better Outcomes

Outcome Wisconsin Median State 

RTW: Not Working At Interview (%) 12% 13%

Median Duration Of Disability (Weeks) 9 weeks 10 weeks

Access: % Reported “Big Problems” 

Getting Desired Care 10% 16%

Satisfaction: % Reported “Very 

Dissatisfied” With Care 9% 13%

Earning A Lot Less At Interview (%) 6% 8%

6

* Statistically Significant

© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin Medical Payments Per Claim 

40% Higher Than Typical

$0

$5,000

$10,000

$15,000

$20,000

MA CA MI TX MN AR FL NC PA LA IL IA NJ VA WI IN

Average Medical Payment/Claim 

Median: $12,167 $16,980

© Copyright 2015 WCRI. All Rights Reserved. 7

2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScopeTM 

Medical Benchmarks For Wisconsin, 15th Edition (2014).
WI Medical Payments Higher

And Have Grown Rapidly

© Copyright 2015 WCRI. All Rights Reserved. 8

Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix And 

Wages; Source: CompScopeTM Medical Benchmarks For Wisconsin, 15th Edition (2014).

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Average Medical Payment/Claim 

Wisconsin

Other Study 

States

AAPC 2007/08 To 2012/13

WI: 6.5%

Median Study State: 4.5%
0

50

100

150

200

250

FL CA SC NC NY OK MI MD PA MA AR TN LA AZ TX MN GA CT VA IA IL MO NJ IN WI

25-State Median = 100 Nonhospital Prices Paid In Wisconsin 

Were The Highest Of 25 States

9

Prices Paid For Nonhospital Services Rendered In 2013 (January Through June)

Source: WCRI Medical Price Index For Workers’ Compensation, Sixth Edition (2014)

States With Fee Schedule No Fee Schedule

© Copyright 2015 WCRI. All Rights Reserved.
Payments Per Claim In WI For Key 

Nonhospital Services 26%–265% Higher

Payments/Claim For 

Nonhospital Services Wisconsin 16-State Median 

% 

Difference 

Pain Mgmt. Injections $1,853 $508 265%

Major Surgery $7,692 $2,595 196%

Minor Radiology $421 $171 147%

Major Radiology $1,649 $832 98%

Evaluation And Mgmt. $1,071 $751 43%

Physical Medicine $3,814 $3,029 26%

10

2012/13 Claims With > 7 Days Of Lost Time, Adjusted For Injury/Industry Mix; Source: CompScopeTM 

Medical Benchmarks For Wisconsin, 15th Edition (2014).

© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin WC Paid Much Higher Prices 

Than Group Health For Knee Arthroscopy

11

Group Health Data Include Copays And Deductibles. Source: A New Benchmark For Workers’ Compensation Fee Schedules: Prices Paid By Commercial Insurers? 

(2013)

$3,728

$1,573

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

MI*

AR

FL

TX

MD

NC

LA

TN*

GA

PA

CA

OK*

VA

IA

NY

MA

AZ

CT*

WI

IN

IL*

NJ

Median WC Price Paid Median GH Price Paid

WC And GH Median Prices Paid, 

2009 (CPT 29881) 

 

* MI, OK, TN, CT, and IL implemented a double-digit fee schedule decrease for a common knee arthroscopy 

(CPT 29881) from 2009 to 2012. 

© Copyright 2015 WCRI. All Rights Reserved.
Wisconsin Average Morphine Equivalent 

Amount Per Claim Lower Than Typical

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

MO IA WI NJ IN MN AR CT FL IL KS TN VA MI GA TX CA SC MD NC MA OK PA NY LA

Avg. MEA/Claim With Narcotics (milligrams) 

Median: 1,861 mg

12

Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, 

Prescriptions Filled Through March 2012

Source: Interstate Variations In Use Of Narcotics, 2nd Edition (2014)

© Copyright 2015 WCRI. All Rights Reserved.
WI % Workers Who Were Longer-Term 

Users Of Opioids Lowest Of Study States

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

WI IN NJ MO IA AR KS MN CT IL TN VA FL MD MA MI SC OK GA CA NC TX PA NY LA

% Of Claims With Opioids Identified 

As Longer-Term Users Of Opioids 

Median: 7%

4%

13

Nonsurgical Claims With > 7 Days Of Lost Time, Injuries From October 2009 To September 2010, 

Prescriptions Filled Through March 2012

Source: Longer-Term Use Of Opioids, 2nd Edition (2014)

© Copyright 2015 WCRI. All Rights Reserved.
▪ Income benefits

▪ Worker outcomes

▪ Medical costs

▪ Medical price indices

▪ Nature of care (e.g., surgery rates, opioid use)

▪ Litigiousness and litigation costs

▪ Medical cost containment expenses

▪ Timely payment to worker

Benchmark Metrics

© Copyright 2015 WCRI. All Rights Reserved. 14
▪ Impact of state reforms

▪ Physician dispensing

▪ Medical treatment guidelines/utilization review

▪ Effect of ACA on WC systems

▪ Medical price regulation

▪ Compounding of Rx medications

▪ Impact of provider choice laws

Topical Studies—Examples

© Copyright 2015 WCRI. All Rights Reserved. 15
▪ How states compare 

▪ Income benefit payments

▪ Worker outcomes

▪ Medical costs and care delivered

▪ Long-term opioid use

Physician dispensing of Rx

Trust in the workplace and worker outcomes

▪ Provider responses to medical price regulation

Outline: 

Illustrations Of Available Information

© Copyright 2015 WCRI. All Rights Reserved. 16
18 States Changed Rules Governing 

Reimbursement For Physician-Dispensed Drugs

© Copyright 2015 WCRI. All Rights Reserved. 17

States Where Physician 

Dispensing Not Allowed In 

General Or Infrequent

CA

FL

SC

NC

IL

OK

MI

AZ TN

IN

GA MS

CT

DE

HI

AL

PA

ID

Reform States 

Focusing On Price 

Reduction Only 

Reform States Further Limiting 

Physician Dispensing To Short 

Timeframe Or Certain Drugs
The Same Drugs, When Physician-Dispensed, 

Are Much Higher Priced

18

Common WC Drugs 

Prescribed By Physicians 

Price Per Pill % 

Physician Difference 

Rx 

Pharmacy 

Rx 

Hydrocodone-acetaminophen 

(Vicodin®) $1.41 $0.52 172%

Ibuprofen (Motrin®) $0.49 $0.27 81%

Tramadol HCL (Ultram®) $1.55 $0.73 114%

Cyclobenzaprine HCL (Flexeril®) $1.85 $0.99 88%

Meloxicam (Mobic®) $5.86 $3.19 84%

Illinois 2011/12 Claims With > 7 Days Of Lost Time With Prescriptions

Source: The Prevalence And Costs Of Physician-Dispensed Drugs (2013)

© Copyright 2015 WCRI. All Rights Reserved.
Does Physician Dispensing Increase 

Opioid Use?

19

Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and 

Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014)

© Copyright 2015 WCRI. All Rights Reserved.

3.9%

0.5%

12.2%

14.2%

12.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Pre-Reform Post-Reform

% Of Workers With Strong Opioids 

Physician 

Dispensed

Pharmacy 

Dispensed

*

* Statistically Significant at the 0.01 level
Does Physician Dispensing Increase 

Opioid Use? Likely

20

3.9%

0.5%

12.2%

14.2%

12.2%

12.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Pre-Reform Post-Reform

% Of Workers With Strong Opioids 

Physician 

Dispensed

Pharmacy 

Dispensed

Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and 

Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014)

© Copyright 2015 WCRI. All Rights Reserved.

* Statistically Significant at the 0.01 level

*
Most Received Physician-Dispensed 

NSAIDs And Weaker Opioids

9.1% 10.1%

24.1% 25.8%

3.9%

0.5%

0%

5%

10%

15%

20%

25%

30%

Pre-Reform Post-Reform

% Of Workers With Physician

-

Dispensed Rx 

© Copyright 2015 WCRI. All Rights Reserved. 21

Underlying data include six months of Rx utilization for FL injuries between Jan.–Jun. 2010 (pre-reform) and 

Jul.–Dec. 2011 (post-reform); Source: The Impact Of Physician Dispensing On Opioid Use (2014)

NSAIDs

Weaker 

Opioids

Strong

Opioids

*

*

*

* Statistically Significant at the 0.01 level
© Copyright 2015 WCRI. All Rights Reserved. 22
Cyclobenzaprine New Strength In California: 

Rapid Increase, Much Higher Prices

0%

10%

20%

30%

40%

50%

60%

70%

80%

7.5 Milligrams 

Price Per Pill Paid: 

$2.90–$3.45

5 Milligrams 

Price Per Pill Paid: 

$0.35–$0.59

10 Milligrams 

Price Per Pill Paid: 

$0.49–$0.70

© Copyright 2015 WCRI. All Rights Reserved. 23

Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2011 (2011Q1) 

To First Quarter Of 2013 (2013Q1)

Calendar Quarters 

% Of Prescriptions For Cyclobenzaprine 

HCL By Strength 
Frequent Dispensing Of 7.5-Milligram Product 

At Much Higher Price Drove Up Physician Price 

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

2010

Q1

2010

Q2

2010

Q3

2010

Q4

2011

Q1

2011

Q2

2011

Q3

2011

Q4

2012

Q1

2012

Q2

2012

Q3

2012

Q4

2013

Q1

Physician-Dispensed Rx Pharmacy-Dispensed Rx

© Copyright 2015 WCRI. All Rights Reserved. 24

 

Calendar Quarters 

Average Price Per Pill Paid For 

Cyclobenzaprine HCL By Dispensing Point 

Included Are Prescriptions (Rx) Dispensed By Physicians In California From First Quarter Of 2010 (2010Q1) 

To First Quarter Of 2013 (2013Q1)
About The “Fear Of Firing” Predictor

Responses % Of Workers In Survey – WI 

Strongly Disagree 51%

Somewhat Disagree 12%

Somewhat Agree 13%

Strongly Agree 24%

25

 Survey question: When injured, I was afraid of 

being fired or laid off?

© Copyright 2015 WCRI. All Rights Reserved.
Those Who Strongly Agreed Were Most 

Likely To Have Worse Outcomes

Outcome Strongly Or 

Somewhat Disagreed 

Strongly Agreed 

(Fearful) 

RTW: Not Working At Interview (%) 10% 21%*

Median Duration Of Disability (Weeks) 9 13*

Access: % Reported “Big Problems” 

Getting Desired Care 9% 20%*

Satisfaction: % Reported “Very 

Dissatisfied” With Care 8% 18%*

Earning A Lot Less At Interview (%) 3% 16%*

26

* Statistically Significant

© Copyright 2015 WCRI. All Rights Reserved.
▪ How states compare 

▪ Income benefit payments

▪ Worker outcomes

▪ Medical costs and care delivered

▪ Long-term opioid use

▪ Physician dispensing of Rx

▪ Trust in the workplace and worker outcomes

Provider responses to medical price regulation

Outline: 

Illustrations of Available Information

© Copyright 2015 WCRI. All Rights Reserved. 27
-10

10

30

50

70

90

110

130

150

170

190

CA

MA

FL

NC

NY

HI

PA

OK

UT

MD

SD

MI

KY

WV

CO

WY

OH

SC

KS

LA

ME

VT

NM

AR

MN

AZ

MS

NE

WA

AL

TX

CT

GA

TN

ND

NV

MT

OR

DE

ID

IL

AK

WC Fee Schedule % Above/Below 

State Medicare Rates, 2011 

 

In Most States, WC Physician Fee Schedule 

Above Medicare Rates By 30% Or More 

28

Source: Designing Workers’ Compensation Medical Fee Schedules (2012)

© Copyright 2015 WCRI. All Rights Reserved.
Lower Prices Associated With More 

Frequent Billing Of Complex Office Visits

© Copyright 2015 WCRI. All Rights Reserved. 29

Common Office Visits In Calendar Year 2012

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IA WI AR TX MI IN MN PA MA VA LA NC IL NJ FL CA

% Of Office Visits Billed As More Complex Average Price—Common Office Visit

% Of Established Patient Office 

Visits Billed As More Complex 

Average Price Paid For Common 

Office Visits 

Correlation Coefficient: -0.6
CA: Most Office Visits Were 

“Intermediate” (CPT 99213)

0%

20%

40%

60%

80%

100%

2004

% Of E&M Services For 

 Established Patients 

Level 1 Level 2 Level 3 Level 4 Level 5

© Copyright 2015 WCRI. All Rights Reserved. 30

E&M: Evaluation & Management

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

$46 

$69 

$104 

Prices 

Paid 
CA Prices Frozen For 3 Years—More 

Office Visits Coded As More Expensive

0%

20%

40%

60%

80%

100%

2004 2005 2006

% Of E&M Services For 

 Established Patients 

Level 1 Level 2 Level 3 Level 4 Level 5

© Copyright 2015 WCRI. All Rights Reserved. 31

$45 

$69 

$101 

$46 

$69 

$103 

$46 

$69 

$104 

Prices 

Paid 

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)
After CA Raised The Fee Schedule, 

Upcoding Stopped

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007

% Of E&M Services For 

 Established Patients 

Level 1 Level 2 Level 3 Level 4 Level 5

© Copyright 2015 WCRI. All Rights Reserved. 32

$46 

$69 

$103 

$46 

$69 

$104 

Prices 

Paid 

$52 

$81 

$107 

$45 

$69 

$101 

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

FS Increase
When The Fee Schedule Was Re-Frozen, 

Upcoding Resumed

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012

99211 99212 99213 99214 99215

© Copyright 2015 WCRI. All Rights Reserved. 33

$104 $103 $101 $107 $113 $116 $116 

$69 $69 

$81 $84 $69 

$84 $83 

$46 $46 $52 $54 $45 

$54 $54 

Prices 

Paid 

$113 

$84 

$54 

Source: Estimating The Effect Of California’s Fee Schedule Changes: Lessons From WCRI Studies (2014)

FS Increase

$83 

$54 

$112 

% Of Office Visits For 

Established Patients 
2003 FL Reforms Reduced Fee Schedule 

Rates For Many Hospital Outpatient Services

Hospital Outpatient Pre-Reform Post-Reform 

Scheduled Radiology 75% of charges 110% Medicare

Unscheduled Radiology 75% of charges 75% of charges

© Copyright 2015 WCRI. All Rights Reserved. 34

Source: CompScopeTM Medical Benchmarks For Florida, 15th Edition (2014)
Lumbar MRIs Were Paid More Often As 

Unscheduled With Higher Rates After 2005

38% 34%

53%

68% 63%

82% 86%

71% 71%

62% 66%

47%

32% 37%

18% 14%

29% 29%

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008 2009 2010 2011 2012

% Of Lumbar MRIs Done In 

Hospital Outpatient Settings 

 

Paid > Nonhospital FS Paid <= Nonhospital FS

© Copyright 2015 WCRI. All Rights Reserved. 35

Claims With > 7 Days Of Lost Time At 12 Months Of Experience, Not Adjusted For Injury/Industry Mix

Source: CompScopeTM Medical Benchmarks For Florida, 15th Edition (2014)
WCRI Is A Resource For You

For further information:

website www.wcrinet.org

Richard Victor 617.661.9274

© Copyright 2015 WCRI. All Rights Reserved. 36