Affordable Care Act – Shocking New WCRI Study
The Affordable Care Act and its effect on Workers Compensation may not be known for many years. At the last WCRI (Workers Compensation Research Institute) Annual Conference (March, 2015 in Boston), a very interesting scenario was brought up by Dr. Richard Victor- WCRI CEO.
The concept of case shifting instead of cost shifting was a very unique viewpoint. WCRI has surprised the Workers Comp community in the past with some of its concepts and follow up studies.
One of the more groundbreaking studies consisted of the WCRI actually contacting former injured employees to understand and analyze their viewpoints of the WC claims process.
In my humble opinion, this is not a concept to be taken lightly. The effects of the Affordable Care Act may not be known for 40 – 50 years as perfect hindsight will be available by that time.
A few of the concerns concerning the Affordable Care Act raised by WCRI were:
- The ACA seeks to greatly expand the use of ACOs―where providers are rewarded for meeting cost and quality goals. This will expand the use of “capitated” health insurance plans. Under these plans, providers are paid a fixed insurance premium per insured regardless of the amount of care provided to a given patient during the year. Under traditional fee-for-service insurance plans, providers are paid for each individual service rendered.
- The study found that a back injury was as much as 30 percent more likely to be called “work-related” (and paid by workers’ compensation) if the patient’s group health insurance was capitated rather than fee for service. The study can be extrapolated to different states―for example, the study predicts about a $100 million increase in workers’ compensation costs in a state like Illinois if the share of capitated patients rises from 12 to 42 percent.
- Case-shifting was more likely in states where a higher percentage of workers were covered by capitated group health plans. In a state where at least 22 percent of workers had capitated group health plans, the odds of a soft tissue case being called work-related were 31 percent higher if the patient was covered by such a plan compared with similar workers covered by fee-for-service group health plans.
- By contrast, in states where capitation was less common, there was no case-shifting seen. This is more than just the result of having fewer capitated patients seeking care. It also appears that when capitation was infrequent, the providers were less aware of the financial incentives.
- The database used is based on a large sample of health insurers and self-insured employers. It includes individuals employed by mostly large employers and insured or administered by a variety of health plans. The database is unique in that, for a given employee, it contains information on both the group health services used and the workers’ compensation services used.
For more information about this study or to purchase a copy, visit here.
Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com