The National Council on Compensation Insurance (NCCI) released a report analyzing trends in home health and skilled nursing services within workers’ comp claims, highlighting significant differences in costs across accident years when segmented by claim size and injury type.
The report also compares the cost of home health and skilled nursing services to indices published by the US Bureau of Labor Statistics and evaluates the effectiveness of home health fee schedules.
Across all claims in 2024, home health’s projected share of total medical costs was 2%, while skilled nursing made up 0.8%. However, more costly claims with longer durations incur significantly greater home health and skilled nursing costs.
For claims with incurred costs between $250K and $500K one year after injury, the projected home health share of medical costs is 2.0% and 1.1% for skilled nursing, while for claims exceeding $1 million, the projected home health share of medical costs is 20.1% and 5.3% for skilled nursing. Furthermore, the share of home health services increases as claims age, reaching 9.4% of total medical costs at 10 years post-injury and approximately 12% by year 30.
Injury type also impacts the utilization of these services as well, considering an injured worker’s level of physical ability. At five years post-injury, spinal cord and traumatic brain injuries account for approximately 60% of payments for home health and skilled nursing.
Since 2020, the average cost per claim for home health services has grown comparable to the US Bureau of Labor Statistic’s Producer Price Index (PPI) for this service. Costs for skilled nursing have outpaced the PPI by a wide margin. In states with home health fee schedules, more than half of services were paid above the allowed amount.
Growing home health and skilled nursing costs may be a significant driver of long-duration claim expenses, especially in cases involving complex, lifelong medical needs. Awareness of these cost pressures helps stakeholders anticipate future medical spending and assess how pricing and utilization trends may shape workers’ compensation systems over time
