Managed Care and Medical Cost Containment in Workers’ Compensation: A National Inventory, 2001-2002

By WCRI

December 1, 2001 Related Topics: Workers’ Compensation Medical Cost Containment

Jurisdictions have turned from adopting new cost containment strategies and are now assessing programs currently in place, measuring results both in terms of costs to employers and of the impact on worker outcomes and quality of care. This is one of the key findings from WCRI’s new inclusive report on medical cost containment initiatives, Managed Care and Medical Cost Containment in Workers’ Compensation: A National Inventory, 2001-2002.

Designed to give policymakers and others a comprehensive understanding of the regulations in all 51 jurisdictions, this detailed reference book is divided into two sections.

The first examines medical cost containment strategies: managed care, treatment guidelines, provider fee schedules, utilization management, bill review, choice of provider and the regulation of hospital charges. The second summarizes the regulatory policies in each of the 50 states and the District of Columbia.

Key Findings:

  • Growth in enacting policies addressing price and utilization management in workers’ compensation slowed in recent years, as few jurisdictions have enacted new cost containment initiatives since 1997 (see table).
  • No new jurisdiction has mandated the use of managed care when treating workers’ compensation injuries since 1997. In fact, some jurisdictions have eliminated this mandate (Florida – system-wide; Vermont – for the residual market).
  • The range of differences in provider fee schedules across states is large – and increasing. Fee levels for those states at the low end generally remained static, while states with fee levels at the higher end tended to increase allowable reimbursement rates.

The most common cost containment measure, in place in almost every jurisdiction, regulates an employee’s ability to choose or change medical providers.

Over 70 percent of the jurisdictions regulate medical provider and hospital prices. Medicare’s resource-based, relative-value scale is the most common basis for designing fee scale reimbursements for the 42 jurisdictions that have medical fee schedules. Of the 43 jurisdictions with statutory authority to regulate hospital prices, 37 do so.

 

 

 

 

 

 

 

 

 

 

Managed Care and Medical Cost Containment in Workers’ Compensation: A National Inventory, 2001-2002. December 2001. WC-01-04.

Copyright: WCRI

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