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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-710

Board Proposes New Workers' Compensation
Medical Fee Schedule

Date: July 28, 2014

The New York State Workers' Compensation Board (Board) is announcing the release of a discussion document on a proposal for a new Workers’ Compensation Medical Fee Schedule.

The New York Workers’ Compensation Medical Fee Schedule has remained virtually unchanged for more than 20 years. During that period advances in medicine have brought about changes to the cost, efficacy and availability of certain procedures, made other procedures obsolete, and generally altered the understanding of quality health care. The existing fee schedule has remained largely insulated from the financial and medical realities of a changing health care market. As a result, some providers and services are vastly overcompensated while others are undercompensated.

For example, the existing fee schedule allows for payment of almost triple the market rate for magnetic resonance imaging. A now relatively common and safe surgical procedure is paid up to 40% more under the existing fee schedule than is paid on average in general health care. Reimbursement for the evaluation and management of patients under workers’ compensation still fall well below that of general health. Additionally, the proposed fee schedule will be expanded to cover services not currently addressed under the existing fee schedule.

Goals of a Fee Schedule Update

Beyond correcting the misalignments with the broader healthcare context, the Board hopes to update its fee schedule annually in an easy and logical manner that will adequately and fairly reimburse medical providers based on the cost and value of services, expand access to care, particularly to primary care specialties and control medical costs.

The Fee Schedule Study

In order to accomplish these goals, the Board began a fee schedule study. The first phase of the study was to contract with a vendor to benchmark current fee schedule rates against the actual fees paid, the Medicare fee schedule, commercial health care payments, and other workers’ compensation fee schedules.

The project studied the feasibility of and proposed a model for a new fee schedule using the RBRVS system maintained by Medicare with Board-specific conversion factors. This study considered key policy issues such as overall spending constraints, geographic adjustments, payment rules, use of single or multiple conversion factors, and how NYS might transition to an RBRVS fee schedule. A key component of the study was to understand and quantify the financial impact of a proposed fee schedule on various provider types.

Feedback

The Board is now releasing the Proposed Medical Fee Schedule Discussion Document on our website. The purpose of this is to give interested stakeholders an opportunity to review and provide feedback on the proposal prior to any official action. We welcome your feedback. Please provide all comments to the Board no later than October 1st via email to feeschedule@wcb.ny.gov.

 

Robert E. Beloten
Chair