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Study: Cost Controls Will Result in 'Case Shifting' to Comp

By Elaine Goodman (medical/business Reporter)

Wednesday, September 30, 2015 | 2623 | 0 | 0 min read

Cost-control measures implemented in response to the Affordable Care Act could result in millions of dollars in medical claims being shifted from group health plans to state workers’ compensation systems, according to a study released Tuesday by the Workers Compensation Research Institute. The WCRI study says the shift would occur as a result of more group health plans paying physicians through a capitated arrangement, in which the doctor receives a set amount per patient, no matter what treatment is provided. In response, a doctor treating an injury such as nonspecific back pain m...

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Comments

Frank Pennachio Nov 3, 2016 07:58 AM

Workplace wellness programs??? Really? Their purported results are made up, and debunked.

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George Corson Nov 3, 2016 07:58 AM

What about the workers who previously used WC claims for health issues because they did not have Health Insurance? This completely ignores that segment. They were usually denied, treated on a Lien basis, and settled for small sums. Then there are the smarter claimants who may/will use their new Health Insurance to actually recover from a WC injury, without the choke-chain of MPN/UR/IMR delays and denials. I think uninsured workers previously used WC to get health treatment, which should slow. Some shady doctors may try to shift some capitated patients into WC, but will probably offset the decreasing claims from the previously uninsured. The use of Health Insurance to treat a minor/moderate work injury without regulatory impediment is wrong, and will shift some claims away from WC, but I can see the individual benefit if someone just wants to recover and work.

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Ralph Mann Nov 3, 2016 07:58 AM

Oh, the irony. The Workers' Compensation Industry has been looking to cost shift industrial medical treatment to the private and governmental sectors and was almost there with the UR and IMR systems being flagrantly abused. Now those sectors are shifting it right back into work comp's lap. Just wait until Medicare starts throwing around Fed muscle and collecting for treatment that was UR denied regardless of state statutes. Doesn't the industry know the story about the sleeping giant? Over reached big time!

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