Texas Requiring Preauthorization: Reduces Costs, Return to Work Not Affected

By requiring preauthorization for occupational therapy services, spinal surgery, and work hardening and conditioning services, a study showed three Texas reforms from the early 2000s lowered medical costs without hurting injured workers’ return to work.

 

 

The Workers Compensation Research Institute (WCRI) study, Impact of Preauthorization on Medical Care in Texas, found when an insurer requires preauthorization there was a seven percent reduction in the number of injured workers receiving physical medicine and occupational therapy. Further, there was a 39 percent reduction in the number of visits per worker. Preauthorization also reduced the number of patients receiving more than 15 visits for physical medicine services.

 

 

According to the study’s abstract, “Texas policymakers enacted several reforms that were intended to give payors additional tools to manage medical care, patient outcomes, and costs. One class of reforms requires preauthorization by the payor for certain types of medical treatments and services.”

 

 

Among the workers compensation rules in Texas, an injured employee is required to receive approval from the insurance carrier before receiving occupational therapy services, spinal surgery, and work hardening and conditioning services.

 

 

To complete the study, WCRI used medical billing data for two sets of claims — one prior to the effective date of the preauthorization reform and one after. The abstract says, “For each type of medical care, WCRI measured changes in utilization after the preauthorization reforms. … WCRI also studied changes in disability duration and return-to-work as measured by the days in which an injured worker received temporary disability payments.”

 

 

1.      What impact does preauthorization have on reducing medical visits?

2.      Does preauthorization hamper return to work?

3.      Did preauthorization create a delay in spinal surgeries for injured workers?

 

 

1.      Return to work did not change significantly over the time period for injured workers who received physical medicine services.

2.      There was a 21 percent reduction in the number of injured workers receiving work hardening and work conditioning services, but not significant changes in the number of visits and services per visit.

3.      Time to surgery was shorter among injured workers who received spinal surgery after preauthorization was effective.

 

 

You can read more about the study here.