With medical benefits representing the single largest cost component for many state workers’ compensation systems, this 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, 2021.

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 four medical cost issues that have received a great deal of attention since the last edition: telehealth, ambulance fees, “balance billing,” and fees for surgically implanted hardware.

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, 2021. Karen Rothkin. March 2021. WC-21-18.

Copyright: WCRI