Workers’ Compensation Medical Cost Containment: A National Inventory, 2024

By Karen Rothkin

Related Topics: Fee Schedules, Litigation and Dispute Resolution, Medical Costs, Workers’ Compensation Medical Cost Containment

With medical benefits representing the single largest cost component for many state workers’ compensation systems, this new study provides a basic understanding of the cost containment strategies used in all 50 states and 3 federal workers’ compensation programs as of January 1, 2024.

The study includes tables of statutory provisions, administrative rules, and processes used by states, which come from surveys completed by state and federal administrators. One of the most popular tables compares fee schedule allowances for eight of the most common medical procedures (e.g., knee arthroscopy, lumbar surgery) in states that regulate fees. New to the report are more details about fee regulations for paying hospitals and ambulatory surgical centers.

Medical cost containment strategies fall into the categories of price management and utilization management—with a goal of either curbing the cost of a particular service or reducing the amount of services provided. Cost containment regulatory initiatives usually 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 workers.

Workers’ Compensation Medical Cost Containment: A National Inventory, 2024. Karen Rothkin. February 2024. WC-24-16.

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Research Questions:

  • What cost containment strategies do our neighboring states use?
  • Which states are using medical treatment guidelines? What do they cover?
  • How do states use fee schedules to regulate hospital, provider, drug, and ambulatory surgery center costs?
  • How do different states determine payment for surgical implants?

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