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Witnesses, commission urge more flexibility in workers’ comp physician fee schedule (H3874)
Summary
Physicians and the Workers' Compensation Commission told a Senate Judiciary subcommittee that South Carolina’s fee schedule for treating injured workers is among the lowest in states with schedules; they urged H3874 to give the commission flexibility to target rates by specialty, add an advisory committee and public hearings, and reduce litigation triggered by a ±10% statutory cap.
Ann Margaret McCraw, CEO of Midlands Orthopedics and Neurosurgery and representing the South Carolina Orthopedic Association, told the Senate Judiciary subcommittee that South Carolina’s workers’ compensation physician fee schedule is “one of the second lowest” among states that use schedules and that the current methodology makes it difficult for physicians to continue treating injured workers.
“This is a real challenge for physicians to continue opening up the doors to these patients,” McCraw said, explaining that the fee schedule ties payments to Medicare and that a 2012 statutory change — a provision that bars the commission from increasing or decreasing rates by more than 10% without triggering appeals — has reduced the commission’s ability to make needed adjustments.
The bill before the panel, H3874, would open flexibility for the South Carolina Workers’ Compensation Commission to use multiple conversion factors and to better incentivize care types most needed by injured workers, McCraw said. The measure would also require an annual advisory committee made up of multiple stakeholders and require public hearings on the fee schedule when it is proposed.
Chairman Beck of the Workers’ Compensation Commission told senators the ±10% provision grew out of the 2012 Medicare imaging cut and has produced an unintended consequence: while the commission reviews rates annually, the cap and related litigation risk have limited meaningful adjustments. “We’ve updated this fee schedule every year,” Beck said, but added the commission lacks tools to target increases by specialty and faces budgetary and litigation constraints that discourage large, targeted changes.
Committee members asked whether the advisory panel should include claimant representation and whether appointments should be made by the commission chair; both suggestions drew support. McCraw and Beck said they would not object to adding claimant or injured-worker representatives to the advisory committee and that appointments by the commission chair would be acceptable.
The subcommittee approved a motion to report H3874 favorably as amended by voice vote and advanced it to the full committee. The committee did not record a roll-call tally; senators voted by voice.
The measure’s proponents framed the bill as an accountability and access fix — coupling greater commission discretion with public hearings and stakeholder input — while opponents were not recorded in testimony during the subcommittee hearing. The next procedural step is consideration by the full committee.
