By PETER ROUSMANIERE, an expert on the workers' compensation industry
The Patient Protection and Affordable Care Act (H.R. 3590) and the quickly enacted revision to it make only glancing reference to workers' compensation. None of the leading proponents in the House or Senate sought to include workers' compensation into their healthcare reform bills. But that in no way rules out the possibility of unintended consequences.
The legislation may in fact have an indirect and marked effect on workers' compensation through altering employee, employer vendor and medical provider behavior.
Joe Paduda, who runs the blog Managed Care Matters and has followed the legislation closely, noted that hospitals will have "less need to cost-shift to workers' compensation to make up for revenues lost due to treating the uninsured," who often fall into the free care category. That would reduce upward pressure on medical charges.
On the other hand, he also predicts that, if Congress cuts Medicare reimbursement, providers may more aggressively bill workers' compensation to make up the difference.
Paduda explained that most state workers' comp fee schedules today are linked to Medicare reimbursement rates and automatically adjust as Medicare rates change. He expects healthcare reform will trigger more changes in Medicare rates.
Paduda is also concerned that some vendors in the workers' compensation field, whose main business is in healthcare insurance, may trim back their commitment to workers' compensation as they address the demanding provisions of the legislation.
Gary Anderberg, practice leader for analytics and outcomes Broadspire, the Atlanta-based Crawford company and third-party administrator, said much of the same.
"My own biggest near-term concern is that much of the work that needs to be done in workers' compensation medical management will languish in the doldrums as healthcare reform sucks up all the available air and energy for the next two or three years," Anderberg said. "We may well find ourselves frozen in place, which does not bode well since so much needs to be enhanced, improved, rethought, recontracted and so forth."
Richard Sabetta, managing director of Risk Navigation, a workers' comp consultancy headquartered in Mandham, N.J., see some good news for claims management.
Sabetta said that risk management practices will sharpen among small to midsize employers, which have been less inclined than large employers to offer health insurance to their employees.
In his experience, these employers are also less likely to be pulling their oar in managing their work-injury risks, particularly in expediting return-to-work for recovering injured workers. He foresees a scenario in which these employers become more proficient at workers' compensation as they acquire new competencies in health insurance purchasing.
Several observers also noted that universal coverage may translate into improved preventive health and management of personal health conditions of workers. That might reduce the rate at which obesity, smoking, uncontrolled diabetes and heart conditions drive up work injury claims costs by prolonging disability.
And a consensus exists in the workers' compensation industry that workers who do not have health insurance are tempted to seek medical care for nonoccupational conditions by claiming they are work-related. Universal insurance coverage may therefore reduce the number of these types of workers' compensation claims.
Still, skeptics out there question just how big an overall effect the Obama healthcare reform will have.
"Healthcare reform may not as yet deal adequately with the critical issue: How we improve the health of the U.S. population, particularly the workforce," said Tom Parry, president of the San Francisco-based Integrated Benefits Institute.
"Our policymakers must understand that health is a key link to the two great issues of the day: healthcare reform and economic recovery. A healthy workforce is a necessity for both," he added.
Stay tuned at WORKERSCOMP ForumTM as the effects of the Obama healthcare reform law upon the workers' comp industry continue to become more apparent.
April 1, 2010
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