WCRI report shows changes in medical cost-containment strategies

With jurisdictions struggling to hold down medical costs in the workers' comp system, most have adopted some sort of containment strategies. A new report shows side-by-side comparisons of what each state is doing.

"Although medical cost containment strategies are constantly evolving, fee schedules and evidence-based treatment guidelines have been the most frequently adopted strategies by states within the past few years," said Ramona Tanabe, deputy director and counsel for the Workers Compensation Research Institute. She said the report updates one produced in 2009.

The cost containment strategies in the report fall into the categories of price management -- controlling the cost of a service, and utilization management -- managing the amount of services provided, WCRI explained. "Cost containment regulatory initiatives usually entail a balancing act: attempting to limit the cost and inappropriate or unnecessary treatment without negatively affecting the quality or access to care for workers."

The report includes web-based tables populated by completed surveys from all U.S. jurisdictions, except California and North Carolina, which declined to participate.

"The responses for California and North Carolina are from the previous (2009) edition of the tables," the report explains. "Where we know the information has changed since the 2009 edition, we have left the tables blank and indicated this with a footnote."

Included in the report's 20 tables are the following:

Application of non-facility provider fee schedules.Characteristics of non-facility provider fee schedules.Comparison of selected fee schedule allowances by current procedural terminology code.Hospital inpatient fee regulations.Hospital outpatient fee regulations.Pharmaceutical fee regulations.Limitation on medical services.Regulations on initial treating provider and change of provider.Authorized primary treating medical providers.Managed care regulations -- mandatory elements.

"Updated tables provide policymakers and system stakeholders with a basic understanding of which strategies have been adopted by which states and provide additional references for those who want more detail," Tanabe said.

Read more at the WorkersComp Forum homepage.

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