Workers’ Compensation Medical Cost Containment: A National Inventory, 2018

By Ramona P. Tanabe, Karen Rothkin

April 10, 2018 Related Topics: Fee Schedules, Litigation and Dispute Resolution, Medical Costs, Provider Choice, Workers’ Compensation Medical Cost Containment

The study provides policymakers and system stakeholders with an inventory of the cost containment initiatives employed by all 50 states, the District of Columbia, and two U.S. Federal programs (Federal Employees' Compensation Act and the Longshore and Harbor Workers' Compensation Act). However, it does not provide written explanations of the initiatives in use by each jurisdiction.

The report contains key features of each jurisdiction’s cost containment initiatives, including  

  • medical fee schedules;
  • regulation of hospital charges;
  • choice of provider;
  • treatment guidelines;
  • utilization review/management;
  • managed care;
  • pharmaceutical regulations;
  • urgent care and ambulatory surgery center fee schedules; and
  • medical dispute regulations.

These initiatives aim to curb the cost of a particular service or to reduce the amount of services provided. Cost containment regulatory initiatives entail a balancing act of limiting the cost of services and inappropriate or unnecessary treatment without negatively affecting the quality of treatment or access to care for injured workers.

Workers’ Compensation Medical Cost Containment: A National Inventory, 2018. Karen Rothkin and Ramona P. Tanabe. April 2018. WC-18-19.

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Research Questions:

  1. What cost containment strategies do neighboring states use?
  2. Which states are using medical treatment guidelines?
  3. How do states use fee schedules to regulate hospital, provider, drug, and ASC costs?

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