Utilization Review in Worker’s Compensation: Current Status and Opportunities for Improvement

Workers’ compensation (WC) systems have multiple components that affect the delivery of patient care and are potentially susceptible to the application of quality assurance (QA) and quality improvement (QI) principles. Utilization review (UR) is an element of WC systems in some jurisdictions and under consideration in others. Insofar as UR can influence physician and payor behavior, it can be a valuable tool for improving clinical outcomes, decreasing disability, and controlling costs. However, certain elements of UR in WC are needed to guard against undesirable consequences. The ACOEM Utilization Review Task Force is providing this initial high-level overview of UR as it relates to WC, with the intent of surveying the WCUR landscape for recommendations on desirable components of an effective and fair system
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