Study explores use of medical treatment guidelines in workers’ comp systems

Cambridge, MA — More than half of U.S. states have not adopted medical treatment guidelines for workers’ compensation cases, a recent study from the Workers Compensation Research Institute shows.

Released Feb. 5, the survey-based study also looks at 22 of the 23 states that either have developed or adopted evidence-based guidelines, which WCRI states are “useful in the delivery of consistent and effective medical care.”

Among those states, a variety of treatment guidelines have been adopted, including some from the American College of Occupational and Environmental Medicine. Researchers reviewed and compared guidelines for the treatment of lower back ailments, and found “large variation in guideline restrictiveness, clarity and ease of use.”

In addition, the researchers examined how state regulations and statutes address utilization review – either prior authorization or after an injured employee received medical care – which is mandatory in 25 of the 49 states surveyed. They also observed how state-adopted medical guidelines are used at different stages in the workers’ comp process and how medical disputes are handled.

In the states that do not have treatment guidelines and “where there is no single payer representing a predominantly large market share,” employers and insurance carriers might set their own guidelines, which may result in inconsistent care for an injured employee, the researchers caution.

“The results from this survey-based study are informative for policymakers and stakeholders who are interested in learning the current policy landscape in this area and identifying opportunities to improve the delivery of medical care for injured workers and enhance system function,” WCRI President and CEO John Ruser said in Feb. 5 press release. “It also provides a framework and lays a foundation for subsequent studies that examine how system features interact with treatment guidelines and what combinations of policies may affect utilization of services and outcomes.”