Affordable Care Act (ACA) Impact on The Future of WC
WCRI – Affordable Care Act (ACA) Impact on WC – Case Shifting was presented by Dr. Richard Victor- the outgoing Director of WCRI. A very popular question that WCRI receives very often.
Whether or not the Affordable Care Act as a cost shift from health to WC with the ACA generating these additional WC claims.
Study by Dr. Dulcamin (?) – Shipyards – Indicated Cost Shifting by HMO’s to WC, as the amount of HMO’s covered shipyard workers, the amount of WC claims increased substantially.
The central part of the ACA’s is ACO’s – Accountable Care Organizations
ACO is basically a network of medical providers that work together in a network to provide care.
Fee for Services vs. Capitated vs. Workers Comp
Fee for services has no motivational aspect to increase WC as ACO’s due as they will end up paying less than Fee For Service or WC.
Accident treatment by Dr. heavily relies on the work relatedness as assessed by the Dr.
Capitation will likely generate claims-shifting due to higher fees paid by WC.
The states where capitation is common there has been a 30% increase in soft-tissue (30%). That is a significant number. States where there is no capitation – there was a 10% reduction in WC soft tissue industries
Interesting comparison –
- Capitation – WC Soft tissue injuries up 30%
- No Capitation- WC Soft tissue injuries down 10%
Fewer workers enrolled in capitated plans – surprising fact
- Year 2000 – Almost 30%
- Year 2013- Less than 15%
High deductible plans (i.e. $2,000)
Has reached 35% of all workers – may have heavy cost shifting if workers has to choose between Workers Comp- first dollar paid or eating a $2,000 deductible.
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