New WCRI Report Tracks Laws for Containing Medical Prices in State and Federal Staff’ Compensation Applications

New WCRI Report Pursues Regulations To Curb Medical Costs For Government And Federal Workers? Compensation programs

• 03/31/21
• WorkersCompensation.com

Cambridge, MA (WorkersCompensation.com) – With medical benefits being the largest component of costs for many government compensation schemes, the Workers Compensation Research Institute (WCRI) today released a new study that provides a basic understanding of the cost containment strategies used in all 50 states and countries 3 Federal compensation programs for employees as of January 1, 2021.

The study, “Containing Medical Costs for Workers’ Compensation: A National Inventory, 2021” contains tables of legal, regulatory, and procedural rules in use by states as of January 1, 2021. The information in the tables comes from surveys conducted by state and federal administrators. One of the most popular tables (Table 4) compares fees for eight of the most common medical procedures (e.g. knee arthroscopy, lumbar surgery) in states that regulate fees.

New to this report are four medical cost issues that have received a lot of attention since the last issue:

• Telemedicine: In the spring of 2020, when many medical practices were physically closed and only offered remote care, some government agencies expanded the use of telemedicine for injured workers. Table 23 describes how telemedicine visits are allowed, restricted, and paid under the compensation rules. It also shows if the rules have been changed due to COVID-19 and if they include expiration provisions.
• Ambulance transport: The workers’ compensation community is increasingly concerned about the rising costs of ambulance transport, especially for air ambulances. Table 24 shows whether a fee regulation, a usage review or some other cost reduction is required for ground and air ambulance services. It also describes how to calculate a maximum allowable fee for jurisdictions that have a maximum.
• Balance Billing: The practice of billing a medical patient for the difference between the provider’s fees and the payer’s payments. It can also describe how a patient is billed for the full cost of the services after the payer declines them. Tables 20 and 24 contain columns that indicate whether credit settlement is prohibited in the jurisdiction.
• Surgical Implants: Surgically implanted hardware is often reimbursed separately from the actual procedure, and not all jurisdictions regulate this payment in the same way. Table 5 has two new columns that indicate whether hardware reimbursements are covered and, if so, the method used to calculate the applicable fee.

“Cost reduction strategies must strike a balance between ensuring workers have access to quality health care, not limiting the cost of services, and avoiding inappropriate treatment,” said Ramona Tanabe, WCRI executive vice president and counsel. “Though they operate differently, all state and federal programs try to do the same thing. This report brings all of this information together to help policy makers and other stakeholders better understand what they might see in their own state and across the country. “

For more information on this study or to purchase a copy, please visit https://www.wcrinet.org/reports/workers-compensation-medical-cost-containment-a-national-inventory-2021. Karen Rothkin is the author of the study.

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