The New York State Insurance Department released the first medical treatment guidelines designed to deliver lower cost care for injured workers.

Eric Dinallo, superintendent of the department, said the proposed guidelines will benefit injured workers while helping to hold down the cost of workers' compensation insurance for employers.

"Putting medical treatment guidelines in place will mean injured workers get faster and more effective medical care at a lower cost to employers," he said. "These guidelines will standardize treatments so injured workers get quality and appropriate care for their condition. Without guidelines, disputes and inappropriate treatments can lead to higher cost but not better care."

Guidelines are product of comp reform. The guidelines are the result of the 2007 Workers' Compensation Reform Act, which was passed earlier this year. After years of deadlock, Gov. Eliot Spitzer announced in March that leaders had reached accord to overhaul the system. Under the law, benefits for injured workers increased for the first time in more than a decade. Benefits have remained the same, despite the fact that workers' compensation claims have been reduced nearly 50 percent since the early 1990s. In addition, employer costs, which are among the highest in the nation, were reduced by 10 percent to 15 percent.

Thus far, Dinallo said the reforms have resulted in an employer cost reduction for workers' comp of more than 20 percent - a savings of about $1 billion per year - and have encouraged new competition among insurance companies to further reduce premiums. The reforms are expected to reduce the time required to resolve disputed workers' comp claims by more than half, which official said will get benefits to injured workers much more quickly.

The medical treatment guidelines were developed under the guidance of the department's Workers' Compensation Reform Task Force. The group was headed by Executive Director Bruce Topman and Project Manager Elain Sobol Berger, who worked with representatives of labor, business, and other state agencies. Dinallo said the participants selected highly credentialed physicians and other professionals to serve as advisors in the creation of the guidelines.

Officials said the guidelines provide a consistent quality standard for the medical care of injured workers. Dinallo said they are evidence-based and reflect the sound clinical judgment of the physicians. Specifically, the guidelines translate the medical literature into a usable and practical tool that assists medical providers in the provision of appropriate health care, he said.

What do the guidelines cover? The guidelines focus on the treatment of injuries of the lower back, cervical spine, knee and shoulder. According to a recent report by the  Workers' Compensation Research Institute,  these injuries account for nearly 60 percent of total medical costs in New York's system.

Dinallo said recent data indicate medical expenses are consuming an increasingly larger share of the total cost of New York's workers' comp system. Medical costs in the state increased to 38 percent of workers' comp benefit costs in 2003 - up from 34 percent in 1994. The medical cost of claims by workers off the job more than seven days grew substantially faster than the rate of medical inflation each year from 1997 to 2002 - rising more than double the climb in the medical Consumer Price Index in some years.

Since New York did not previously have medical treatment guidelines, Dinallo said neither medical practitioners nor claims examiners for insurance carriers have agreed-upon easily accessible standards of care. This could result in disputes over how to treat an injured worker. Such disputes may delay care and, with the added costs for dispute resolution, harm both employee and employer, he said.

In addition, Dinallo said that because different insurance administrators or carriers may use different tools to assess appropriateness of care and control costs - a process called utilization management or review - workers with the same condition may be treated differently simply because they are covered by different insurance companies. Officials said they hope the use of the new guidelines will help eliminate such variations in treatment, reduce disputes about appropriate medical care, and lead to decisions rooted in sound, evidence-based medicine, promoting quality care.