The National Council on Compensation Insurance (NCCI) Annual Insights Symposium (AIS) 2023 presentation titled Under the Microscope: Medical Trends in Comp Guide described changes in the utilization of physician services over time, from 2012 to 2022.

During that period, average utilization per claim over studied states increased modestly. A decrease in utilization due to less severe diagnoses and fewer major surgeries was more than offset by increased physical therapy. NCCI’s Physician Service Utilization – A Multistate Review extends the AIS research to consider variations in the utilization of physician services across states in a given year.

NCCI’s Physician Service Utilization – A Multistate Review webinar examines an analytic method to deconstruct differences in physician service utilization between states into contributions from differences in injury mix and medical treatment. The Physician Service Utilization – A Multistate Review Guide provides a slide-by-slide examination of the key insights, data sources, and background underlying the presentation.

– – Physician service utilization differs across states. They range from a low of $800 to around $3,000, with the all-state average right about $1,800.
– – Patterns of interstate variation have been stable over the past decade.
– – Utilization variations reflect state differences in injury mix, likelihood of major surgery, and service intensity.
– – Interstate variations bigger than +/ 10% are mainly driven by differences in the intensity of nonsurgical medical services.
– – Differences in injury mix and likelihood of major surgery are lesser drivers of utilization variation, though significant in some states.
– – For most states, the change in utilization between 2012 and 2022 was modest.
– – Interstate physician utilization variations have remained stable over the past decade – the order of state differences has remained consistent between 2012 and 2022.
– – Service intensity emerges as the primary factor behind interstate variations in physician utilization for many states.
– – While differences in injury mix and the likelihood of major surgery do play a role, their impact on utilization variation is comparatively smaller, although notable in specific states.
– – In many states, physical therapy (PT) drives physician service intensity – especially for claims without surgery.
– – Three major body systems – back/neck, shoulder, and leg/foot (includes leg, knee, ankle, and foot) account for nearly 60% of injuries in 2022 for the all-state category.
– – The mix in individual body systems does not have a particular correlation with the differences in utilization. Instead, they uniformly contribute, to some extent, to the percentage difference in physician service utilization.

NCCI has looked to see if common features of state medical regulation correlate with or explain these variations. Examples are features such as workers compensation treatment guidelines, the use of fee schedules, network penetration, and the like. That investigation led it to understand that there was not any single feature that can explain these variations.

For additional insights, check out the Physician Service Utilization – A Multistate Review Guide. This comprehensive resource is a companion to the webinarand offers a slide-by-slide examination of the key insights, data sources, and background underlying the presentation.