Impact of Preauthorization on Medical Care in Texas


June 1, 2011 Related Topics: Return to Work, Utilization

Reforms that were intended to give payors additional tools to manage medical care, patient outcomes, and costs. One class of reforms requires preauthorization by the payor for certain types of medical treatments and services.

Under the Texas Division of Workers’ Compensation rules, preauthorization of medical care for injuries covered by workers’ compensation is the responsibility of the insurance carrier and is subject to a process prescribed by the rules.  Among those rules, the requestor or employee is required to request and obtain approval from the carrier prior to providing or receiving a medical service. 

WCRI’s study, Impact of Preauthorization on Medical Care in Texas, helps policymakers and other stakeholders quantify the impact of these reforms on physical and occupational therapy services, work hardening and work conditioning services, and spinal surgeries received by injured workers who were covered by the Texas workers’ compensation system.

For each type of medical care, WCRI measured changes in utilization after the preauthorization reforms were effective using detailed medical billing data for two sets of claims—one prior to the effective date of the preauthorization reform and one after the effective date. WCRI also studied changes in disability duration and return-to-work as measured by the days in which an injured worker received temporary disability payments.

Impact of Preauthorization on Medical Care in Texas. June 2011. WC-11-34.

Copyright: WCRI

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Research Questions:

  1. What impact does preauthorization have on reducing medical visits?
  2. Does preauthorization hamper return to work?
  3. Did preauthorization create a delay in spinal surgeries for injured workers?

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