WCRI just released its annual Medical Cost Containment Inventory for 2024. Below are simple takeaways worth knowing about.?
- 32 jurisdictions recognize Utilization Review as a medical management service.
- Rules, requirements, appeal process, etc. all vary between states - a very important note for compliance, outcomes and penalties.
- 39 jurisdictions either recognize Physician Assistants (PA) as medical providers who can treat injured workers, or state they must be referred by the treating physician to be a medical provider.?
- Using PAs as Level 1 reviewers can create strong quality and faster approvals of appropriate care.
- 14 jurisdictions have some kind of UR mandates to ensure that treatment is reasonable and necessary
- 14 jurisdictions have requirements that UR organizations be certified by the state to perform the service
- 23 jurisdictions have adopted medical treatment guidelines to improve quality and consistency of care in a cost-effective manner.
- Florida does have formal UR regulations - this is a consistent topic of conversation.
- UR is a tool that regulatory bodies believe can improve care and control costs.
- Blanket UR programs that don’t consider the details of each jurisdiction will cause more harm than good.
- When UR is done well (emphasis added), injured workers receive better care, claims close faster, and they close at reduced costs.
Great Job??