New Study Explores Affordable Care Act’s Impact on Workers Compensation

Seriously Injured Employees Not Protected When Companies Opt Out of Workers’ Comp

A new study conducted by the Workers Compensation Research Institute (WCRI) explores whether medical providers and their health care organizations are classifying cases as work-related, depending on financial incentives.

Due to some provisions of the Affordable Care Act, more medical providers are agreeing to capitation agreements. Capitation is a set payment for each plan member over a period of time. A fee-for-service model pays the provider and health care organization for each new service.

Under Workers Compensation Law, doctors make the decision whether an injury is work-related or pre-existing. With certain injuries, especially soft-tissue ailments, it can be unclear whether they were work-related injuries or not.

Because Workers Compensation reimbursement is established by law, and the price points tend to be higher, cases classified as work-related can bear higher financial incentives. The financial benefit can be even higher if providers already have capitation agreements, because most work-related injuries are reimbursed on a fee-for-service basis.

What does this mean for Workers Comp costs?

The study found that case-shifting only occurred where capitated plans were very common. In fact, the WCRI found that “patients covered by capitated group health plans were 11% more likely to have a soft-tissue injury called work-related than a similar patient covered by a fee-for-service group health plan” (WCRI, 2015).

According to the study, if only 3% of group health cases were shifted to Workers Compensation, Workers Comp costs would increase by $225,000,000 in a large state like California, $100,000,000 in a state like Pennsylvania, and $25,000,000 in a state like Iowa.

Learn more about the study here.

Sources:

http://www.wcrinet.org/result/will_aca_shift_wc_result.html?utm_source=ACA+Shift+-+General&utm_campaign=Will+the+ACA+Shift+Claims+to+Workers%27+Comp%3F&utm_medium=email

http://ww2.cfo.com/workers-compensation/2015/10/trendy-health-care-payment-scheme-hikes-workers-compensation-costs/

Posted on November 16, 2015 @ 3:22 pm

Comments are closed.