Risk & Business Magazine Spectrum Insurance Magazine Fall 2017 | Page 25

WISCONSIN WORKER’S COMPENSATION
Wisconsin Worker’s
Compensation Fee Schedule
Back On The Table
T
he Wisconsin Worker’s
Compensation Advisory
Council (WCAC) has
developed legislation to
implement a worker’s
compensation fee schedule. Legislation
has been proposed in the past, and it’s
unclear if there is enough traction in
the state legislature to get a fee schedule
approved.
The WCAC would require the Department
of Workforce Development (DWD) to
develop a medical fee schedule that
approximates the average negotiated
price of group health in Wisconsin. In
developing the fee schedule, DWD would
utilize available data sources, including
surveying self-insured employers to request
price data by CMS CPT codes. The fee
schedule would be constructed initially by
applying a percentage increase to Medicare
rates. This would result in the fee schedule
approximating the average negotiated
group health price.
Annually thereafter, the fee schedule would
be adjusted by an amount equal to medical
inflation. The department would repeat
the data collection and analysis in order
to reset the medical fee schedule rates
every 10 years. The fee schedule would
include a 2.5 percent increase above the
DWD-determined average negotiated
group health price to reimburse medical
providers for administrative expenses
associated with worker’s compensation
claims unless providers bring data forward
to DWD that proves the amount of
uncompensated administrative expenses
associated with such claims is higher than
2.5 percent but no higher than 10 percent.
The fee schedule would be in place starting
January 1, 2019.
WHY IS THE FEE SCHEDULE
DISCUSSION BACK?
Wisconsin Manufacturers & Commerce
(WMC) appears to be the driving force
behind the movement to implement a
fee schedule. WMC argues that despite
the reduction in work-related injuries
from 1994 to 2014, medical costs for
worker’s compensation claims continue
to skyrocket. Medical bills have increased
over 450 percent per claim over that same
period.
KEY FACTS WHY A FEE SCHEDULE IS
NEEDED ACCORDING TO WMC
Wisconsin is the most expensive state
for worker’s compensation medical
payments
•
•
•
60 percent above the median for
2014/15 for injuries with at least
seven days lost time
47 percent above the median for
2014/15 for all injuries
39 percent above the median for
injuries with at least seven days
lost time 2012/15
Wisconsin has the highest hospital
and nonhospital outpatient payments
per claim
Wisconsin has the most expensive
nonhospital prices
Wisconsin has the most expensive
outpatient claim payments
Wisconsin has the fastest growth of
medical costs in the nation
Wisconsin has a significant difference
between group hea lth prices and
worker’s compensation prices, even for
identical procedures
BY: eivind
oland
INSURANCE COUNSELOR & ADVISOR
• Knee Arthroscopy costs 237
percent more under worker’s
compensation
• Shoulder Arthroscopy costs 221
percent more under worker’s
compensation
• Rotator Cuff repair costs 180
percent more under worker’s
compensation
Wisconsin is only one of six states
not to have a medical fee schedule for
worker’s compensation. Many states
allow employers to direct care of
injured workers, similar to how group
health works.
States without a fee schedule typically
are the most expensive states
Wisconsin is only state without a
medical fee schedule or employer-
directed care
From 1994 to 2014, annual medical
costs in Wisconsin for worker’s
compensation have risen from $314
million to $648 million despite a
significant reduction in claims. +
Eivind Oland has 36 years of commercial
property & casualty and risk management
experience. During his career, he has gained
extensive knowledge in the insurance field
as a multi-line underwriter, commercial
lines marketer and account executive.  He
is currently a Certified Insurance Counselor,
an Accredited Advisor in Insurance and
a Certified WorkComp Advisor. He can
be reached at 715.858.5025 or e.oland@
spectruminsgroup.com
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