Idaho Industrial Commission Public Hearing October 15, 2007

© Ingenix, Inc. 2 Using Information to Form Conclusions: Idaho Professional Services Information from SIF  Medicare  Ingenix Data  Health Plan Data  Surrounding States  External Resources  102% Above Transitional Medicare  Greater than 80 th Percentile  3 rd highest of 7 neighboring states  Resources indicate high reimbursement Remaining ‘As Is’ to Revised Methods Likely Stakeholder Meetings; TBD

© Ingenix, Inc. 3 Key Findings  Using the 2006 data studied with the current conversion factors, the IIC is approximately 102% above Idaho Medicare.  The 36 individual conversion factors have considerable variances in amounts on a type of service basis when using Medicare as a benchmark.  The IIC schedule was analyzed using the Ingenix MDR 50 th and 80 th allowed percentiles. IIC reimbursement was greater than the 80 th percentile.  For select codes, (top 20 work comp codes), IIC is 3 rd highest among its neighboring 7 states.  Idaho has the lowest number of physicians per 100,000 population. Incentives may be required so that physicians treat workers’ compensation patients.  The needs of the injured employee are most important - Access to care must not be hindered.

© Ingenix, Inc. 4 The IIC Proposal  Idaho Industrial Commission is proposing ten conversion factors.  Modeling the IIC proposal using the Top 500 criteria shows:  Near budget neutral results  Increases to: –Medicine Codes –Surgery Group 3 –Surgery Group 5  Decreases to: –Surgery Group 1 –Surgery Group 2 –Surgery Group 4  Radiology and Path / Lab remain the same  Note on case mix / reduction of conversion factors  Minimal changes in type of service category impact using Top 500 criteria.  Percentages above national Medicare range from 269% for Surgery Group I to 19% above national Medicare for Medicine Group I

© Ingenix, Inc. 5 Conversion Factor Comparison: Proposed vs. Other National and State Benchmarks

© Ingenix, Inc. 6 Credits / Acknowledgements  CPT only copyright American Medical Association. All Rights Reserved. CPT codes, descriptions, and other CPT material only are copyright American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein.  Some information from CMS.gov  State of Montana:  State of Utah: e%20Guidelines%20%202007% pdf e%20Guidelines%20%202007% pdf  State of Oregon:  State of Washington: hlights hlights