Medical Treatment Guidelines

What does Medical Treatment Guidelines mean?

Medical treatment guidelines include information, policies, and procedures which outline the course of necessary treatment for an injured worker who has filed a workers' compensation claim. Guidelines differ by state, but generally involve steps to create "a system of evaluation and treatment guidelines for high cost or high frequency categories of occupational injury and disease."

These guidelines are used by medical providers to ensure appropriate medical care is provided at a reasonable cost. Guidelines in New York are expanded to include "evidenced based care which is supported, "by the strongest medical studies when available; and, in the absence of strong medical evidence, they are based on the consensus of experienced medical professionals."

Some states accept the medical treatment guidelines as an educational tool. Doctors are expected to familiarize themselves with the appropriate treatments but may have some latitude in how the expectations and procedures are used. In other states, however, the rules are more than guidelines and must be followed with prior authorization required for any services that exceeds the state's guideline limits.

Critics of medical treatment guidelines

Critics of medical treatment guidelines claim states which conform too strictly to the medical treatment guidelines may reduce the autonomy of the doctor-patient relationship. In fact, critics argue the doctor closet to the patient and who is most familiar with their care will know what is best to help the injured worker reach their maximum medical improvement (MMI).

Proponents of medical treatment guidelines, however, claim they are needed to help ensure all injured workers receive good quality medical care and that medical costs are contained and controlled.

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