RAND Makes Recommendations on
Workers’ Comp Treatment Guidelines
[Posted 12/02/04]

The RAND Corporation recently published its recommendations regarding medical treatment guidelines for injured workers in California. The study, commissioned by the State Commission on Health and Safety and Workers’ Compensation, analyzed a number of nationally recognized standards of care, including various utilization review guidelines. Last year’s workers’ compensation law changes require the state to, for the first time, adopt treatment and utilization review standards.

RAND’s panel of physician reviewers found shortcomings in all the existing, major utilization schedules—including those of McKesson/InterQual, InterCorp, American College of Occupational and Environmental Medicine (ACOEM), and American Academy of Othopaedic Surgeons (AAOS). The RAND panel, however, found reason to support the ACOEM guidelines and the physician reviewers recommend that the state adopt the ACOEM Guidelines, supplemented by the AAOS Guidelines for lumbar spinal fusion surgeries.

The RAND proposal is largely consistent with CMA’s recommendations. CMA has urged the Division of Workers’ Compensation (DWC) to adopt treatment and utilization rules based on the ACOEM guidelines and supplemented by the national specialty society guidelines. CMA also recommends that the medical decisions of the treating physician be presumed correct in cases where the treatment is not specifically addressed by the guidelines.

DWC has scheduled a public hearing to discuss the RAND recommendations. CMA will testify at the hearing, which will be Monday, December 6, in San Diego.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.