Frequently Asked Questions

This section contains answers to questions frequently asked by the public. To ask questions that are not answered here, please send us an email at workerscomp@umassmed.edu .

What are the primary concerns of policymakers regarding the provision of medical care to workers who are injured on the job?

Injured workers need accessible, high-quality medical care that enhances their return to productive work and employers need assurances that the care provided is appropriate and cost effective. These needs reflect three broad areas of concern:

1. Access to Care
2. Costs of Care
3. Quality of Care

For an overview of these concerns, go to the fact sheet entitled Workers' Compensation Medical Care: Providing Treatment for Injured and Sick Workers.

For an orientation course on these issues,  click here.

What are some of the barriers to healthcare access for workers injured on the job?

Obtaining appropriate medical services for occupational conditions in a timely manner can be a complicated process. Many potential barriers to workers' compensation medical care exist. A listing and more general information about access to medical care can be found in the fact sheet entitled Access To Workers' Compensation Medical Care: Getting The Right Treatment At The Right Time . Results from the Workers Compensation Health Initiative that provide solutions to help reduce barriers to medical care for workers can be found here .

Why are costs of medical care for injured and ill workers such a concern to policymakers?

Details on the costs of medical care in workers' compensation, cost containment strategies being used by states and summary results of some recent studies on the impact of these cost containment strategies can be found in the fact sheet entitled Workers' Compensation Medical Care: Controlling Costs . For more information on what cost containment strategies individual states have implemented see:

Tanabe, Ramona P, and Murray, Susan M, "Managed Care and Medical Cost Containment in Workers' Compensation A National Inventory, 2001-2002" Workers' Compensation Research Institute, December 2001.

Eccleston, Stacey M. and Zhao Xiaoping, "The Anatomy of Workers' Compensation Medical Costs and Utilization: Trends and Interstate Comparisons, 1996-2000" Workers' Compensation Research Institute, July 2003.

What are the emerging trends in measuring quality of medical care provided to injured and ill workers?

Progress is being made on building methods and tools to measure quality care, but additional strides will depend on how quickly and to what extent they are implemented. Some of the activities designed as a part of the Robert Wood Johnson Foundations' Workers' Compensation Initiative are:

• Building systems of accountability
• Changing clinical practice
• Establishing effective assessment
• Creating an Information Infrastructure
• Providing Resources for Improvement

Actual tools and methods have been created to begin collecting data to measure quality of care. See in particular:

• Development of a Performance Measurement Set for Workers’ Compensation Managed Care Organizations
• The Development and Testing of A Standardized Workers’ Survey As A Tool For The Potential Development of a National Interstate Database for the Study of Workers' Compensation Medical Care Outcomes (WINS)

Additional information about the challenges to improving the quality of care and details of the above activities can be found in the fact sheet entitled Workers' Compensation Medical Care: Improving the Quality of Care for Injured and Sick Workers.

Where can we find a list of publications about WC medical care?

• See " publications "
• A brief bibliography is provided under "references" in the Tool Box section .
• Additional publications can often be found on " related links "
• Search the following publications using keywords occupational health; quality; disability; rehabilitation; or reemployment:
  • American Family Physician
  • American Journal of Occupational Nursing
  • American Journal of Industrial Medicine
  • Healthplan Magazine
  • Integrated Benefits Institute
  • Journal of Ambulatory Care Management
  • Journal of Occupational and Environmental Medicine
  • Journal of Occupational Medicine
  • Journal of Occupational Rehabilitation
  • Journal of University of Occupational and Environmental Medicine (Japan)
  • Journal of Workers' Compensation
  • Medical Care
  • Medical Care Research and Review
  • Minnesota Physician
  • Occupational Hazards
  • Occupational Medicine: State of the Art Reviews

What information is available on use of managed care in workers' compensation?

Although the term "managed care" has multiple definitions and takes multiple organizational forms, several studies have now been done on the use of "managed care" in workers' compensation. Here is a partial listing of books and journal articles that may be of interest on the subject:

Articles/Books on Managed Care

• Bernacki, E.J. and J.A. Guidera. 1998. The Effect of Managed Care on Surgical Rates Among Individuals Filing for Workers' Compensation. Journal of Occupational and Environmental Medicine 40(7): 623-31.
• Bernacki, E.J. and S.P. Tsai. 1996. Managed Care for Workers' Compensation: Three Years of Experience in an "Employee Choice" State. Journal of Occupational and Environmental Medicine 38(11): 1091-7.
• Cheadle A., T.M. Wickizer, G. Franklin, K. Cain, J. Joesch, K. Kyes, C. Madden, L. Murphy, R. Plaeger-Brockway, and M. Weaver. 1999.  Evaluation of the Washington State Workers' Compensation Managed Care Pilot II: Medical and Disability Costs. Medical Care 37(10): 982-93.
• Fox, S.E., R. Victor, X. Zhao. 2001. The Impact of Initial Treatment by Network Providers on Workers' Compensation Medical Costs and Disability Payments. Cambridge, MA: Workers Compensation Research Institute.
• Greenberg, E.L. and R. Leopold. 1998. Performance Measurement in Workers' Compensation Managed Care Organizations. In Occupational Medicine: State of the Art Reviews. ed. J.S. Harris. 13(4): 755-772.
• Johnson W.G., M.L. Baldwin, and S.C. Marcus. 1999. The Impact of Workers' Compensation Networks on Medical Costs and Disability Payments. Cambridge, MA: Workers Compensation Research Institute.
• Kyes, K.B., T.M. Wickizer, G. Franklin, K. Cain, A. Cheadle, C. Madden, L. Murphy, R. Plaeger-Brockway, and M. Weaver. 1999.  Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project I: Medical Outcomes and Patient Satisfaction. Medical Care 37: 972-81.
• Bernacki, E.J. and J.A. Guidera. 1998. The Effect of Managed Care on Surgical Rates Among Individuals Filing for Workers' Compensation. Journal of Occupational and Environmental Medicine 40(7): 623-31.

Journals on Managed Care

The PubMed service of the National Library of Medicine provides a free bibliographic search engine. Access to numerous references and citations can be found by typing in the key words such as quality medical care; disability; occupational injuries; occupational disease; rehabilitation; or reemployment. In addition

• American Journal of Industrial Medicine
• Health Affairs
• Health Services Research
• Journal of Occupational Rehabilitation
• Journal of the American Medical Association
• Journal of Occupational and Environmental Medicine

What are the primary issues and concerns being discussed in various states about workers' compensation medical care?

Business continues to be concerned about the cost of medical treatment and the related disability for work related injuries; and Labor continues to be concerned about the quality of medical care provided to injured or ill workers and the level of benefits they receive. The following are issues that are currently or have recently been topics of legislation or related debates:

• The state of Florida has repealed their mandatory use of managed care. This was the only state mandating the use of managed care for occupational injuries in the US.
• A number of states (e.g. Florida, Massachusetts, Pennsylvania), continue to look at issues related to fee schedules; their impact on access to care for workers and their affect on utilization and costs. Challenges facing states with low per service fees for providers include public policy decisions that may increase costs or redistribute fees from one group of providers to another.
• Most states continue to be concerned about the quality of medical care being provided to injured and ill workers. However, measuring the quality of medical care is still in its infancy and is highly dependent on the data available. In general, public funds are not being made available to improve data availability, as most states have had to cut agency budgets during the most recent legislative sessions.

Where can Injured Workers find information about how medical care works in the workers' compensation system?

A brochure is available here for workers injured in Massachusetts. Other injured workers should contact their state's workers' compensation agency for specific information about their state system.