WCRI – Blogging Live – Case Shifting and Fee Schedules
WCRI WC Case Shifting and do fee schedules.
Preliminary Findings
Dr. Osleya Formenko – Author – Impressive- Received Her Doctorate From Our HQ City Raleigh – UNC
Dr John Gruber- Dartmouth Institute
Dr. John Ruser – Presenter
There are many numerous articles on this blog concerning fee schedules
Workers Compensation usually pays more than Health.
Expect that claims shifting is more likely in the states that have higher WC rates than health.
Workers Comp is fee for service – more lucrative
The treating Dr. makes the work-relatedness call
Fractures lacerations contusions are obvious work relatedness
Back strain, knee strain, soft tissue
Dr. Gruber and Dr. Formenyko found that 20% increase in treatment prices = 6% increase in WC claims vs health
The research indicated that there is a much larger cost factor than may be realized by the 6% when specific states are analyzed such as Texas and Illinois.
The claims shifting for soft tissue injuries have more of an impact of case shifting to costs that are borne by employers in that state.
There will be further studies performed in the future to see if the number of WC cases / case shifting occurs in states that have a higher variability between health insurance and WC rates ICD 10 codes, etc.
A great question- Some physicians have said that WC pays less than health insurance, research and data said WC pays more.
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