Treatment Guidelines Are About Controlling Costs

It occurred to me reading this morning's news that medical guidelines aren't really about providing the best medical care to an injured worker, but to minimize disputes in court about the provision of and payment for medical procedures.

The Louisiana Workforce Commission (LWC) says medical treatment guidelines implemented July 15 already have saved the state's workers’ compensation system approximately $2.5 million in potential litigation costs.

How?

LWC, in a statement on Monday, explained that, “If the recommended care falls within the guidelines, it should be approved automatically by the employer or insurance carrier. If it falls outside the guidelines, an insurance carrier can deny it.”

The commission noted that prior to implementation of the medical guidelines on July 15, all medical disputes were litigated in court, “where they would take an average of 15 months to resolve.”

By contrast, the commission reported, 98 medical disputes had been submitted to the medical director as of Sept. 30 and were resolved in an average of days.

The commission said the new method of resolving disputes “has eliminated the need for depositions, independent medical exams, second medical opinions, court reporters and attorney fees in each of those cases.”

Costs for resolving the disputes under the previous system typically were “in the neighborhood of $25,000 per case,” so the commission calculates that keeping the 98 disputes out of the courthouse saved approximately $2.5 million.

So, I finally get it. Treatment guidelines aren't about providing quality care to injured workers. They're all about controlling costs, which may or may not be good in the long run depending on where you sit on the cost control equation.

I'd have preferred to see a report from LWC that since the adoption of treatment guidelines the return to work rate of injured workers has improved, or that medical severity has decreased, etc.

I suppose eventually those statistics will eventually be disclosed. Until then, for states that don't yet have treatment guidelines, LWC's experience provides argument for their adoption because controlling costs is what workers' compensation seems to be all about these days.

(The Louisiana Association of Self-Insured Employers (LASIE) is challenging the commission’s adoption of the guidelines contending that the guidelines are not “evidence-based,” as required by the Legislature, and were not adopted in accordance with open meetings law requirements.)

workers compensation, work comp, injured worker