Delaware task force rejects motion to create Medicare-based PIP fee schedule
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Summary
A motion to investigate establishing a Personal Injury Protection (PIP) medical fee schedule tied to a percentage/multiplier of Medicare rates failed on a 4–13 roll-call vote after insurers argued a Medicare-based approach offers coding predictability and providers warned it could reduce payments and threaten access to care.
A Delaware automobile insurance reform task force voted down a motion to further investigate establishing a PIP medical fee schedule tied to a percentage or multiplier of Medicare reimbursement, with the roll-call result reported as 4 yes and 13 no.
The motion asked staff to study a medical fee schedule for PIP that would include protections such as statutory prompt-payment rules and consideration of available PIP limits. Proponents described a fee schedule as a way to create predictability in how medical procedures are coded and priced; opponents, particularly clinicians, said the approach could reduce physician reimbursement and lead some providers to stop treating PIP patients.
Eric Goldberg, speaking for industry stakeholders, described the term "Medicare-based" as shorthand for a predictable coding and pricing framework rather than a literal commitment to accept Medicare rates. "When we say Medicare based, we say that because everyone's familiar with the way Medicare codes each procedure," he said, and added that a fee schedule could be implemented as a multiplier of Medicare rather than a cap. Goldberg argued the primary objective is predictability, not simply lowering fees.
Several physicians and clinicians on the task force urged caution. One participating doctor said a Medicare-based rate would often reimburse less than current private payments and could imperil primary-care and other clinicians who now treat PIP patients. Providers raised concerns about unpaid services when claim settlements are delayed and about the administrative burden of moving disputes into court or another enforcement forum.
Members on both sides said actuarial analysis is needed before any fee-schedule proposal could be measured for real premium impact. Industry representatives said actuarial firms could model hypotheticals (for example, pricing procedures at 150% of Medicare, 250% of Medicare, or Medicare levels) and quantify potential savings. Several members therefore favored keeping study language in place rather than immediate adoption.
The motion to pursue the fee-schedule recommendation failed 4–13. Task force leaders said the final report will include the full record of discussion and that the group will reconvene for a final roll-call vote on the package at its March 9 meeting.