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With medical benefits representing the single largest cost component for many state workers’ compensation systems, the Workers Compensation Research Institute (WCRI) released a new study today that 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, Workers’ Compensation Medical Cost Containment: A National Inventory, 2024, 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.

The following are among the regulations that the study tracks:

– – ;Professional and facility fee regulations covering different providers
– – Limitation of some types of medical services
– – Choice of initial treating provider and change of provider regulations
– – Regulations covering managed care and use of treatment guidelines
– – Rules covering timely payments to providers, fines, and dispute resolution

“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 number of services provided,” said Ramona Tanabe, president and CEO of WCRI. “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.”

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Cambridge, MA. Organized in late 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI’s diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

For more information on this study or to download a copy, visit the WCRI website. Karen Rothkin is the author of the study.