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Consistent guidelines needed for treatment of comp claimants: NCCI speaker


ORLANDO, Florida — Workers compensation insurers and state lawmakers should implement consistent, evidence-based medical guidelines to improve treatment for comp claimants and control spending, said Joseph Paduda, principal of Madison, Connecticut-based consulting firm Health Strategy Associates L.L.C.

“Science is not state-specific,” Mr. Paduda said Friday during a presentation at the National Council on Compensation Insurance Inc.’s “Annual Issues Symposium” in Orlando, Florida. “It is bewildering to me why State A has to have different clinical guidelines than State B, other than for political reasons, which is obviously the only reason they would. Treating people in Idaho is the exact same as treating people in Florida, or at least it should be.”

Mr. Paduda discussed several strategies to reform medical care delivery to workers comp patients. In addition to suggesting increased use of evidence-based guidelines, he said adopting workers comp prescription drug formularies similar to those in Texas and Washington state, which restrict the number of drugs available, would help other states to achieve significant savings on drug costs.

He cited recent data from the California Workers’ Compensation Institute, which found that workers comp payers in California would save 27% on prescriptions if they paid only for medications allowed by the Texas workers comp formulary. California payers would save 69.1% on drug costs by using the Washington state formulary, according to Oakland, California-based CWCI.

“We can restrict the use of inappropriate medications through tight formularies,” Mr. Paduda said. “And I would suggest the tight formulary to look at is the one that’s already been developed in Washington that’s working pretty darn well there. No need to reinvent the wheel.”

Additionally when possible, Mr. Paduda recommended that insurers and employers direct medical care for injured workers to help manage medical treatment and costs. He said that states should allow a stronger workers comp utilization review processes that would hold physicians and medical providers accountable for providing evidence-based care to comp claimants.