Health reform and workers comp – the view from IAIABC

Reform – whether it happens this year, in ten years, in one big change or a series of smaller steps – is going to have a big impact on workers comp.
That’s the takeaway from one of the sessions yesterday morning at IAIABC’s annual conference.
Greg Krohm, Director of IAIABC, Dr. Dan Juniga, Medical Director of the Minnesota State Fund, Todd Brown, head of compliance for Coventry workers comp, and I were on a panel discussing health reform, universal coverage, and the impact of same on comp.
First, kudos to the other panelists. Dr Juniga gave an excellent overview of the history and impact of Medicare’s Sustainable Growth Rate – the mechanism that in theory determines Medicare physician reimbursement. Dan pointed out that the failure of SGR to be implemented over the last six years means CMS will now have to cut physician reimbursement by 21.5% on January 1, 2010. Of course, this isn’t going to happen – but the failure of SGR to work will result in Congress eliminating the SGR or otherwise significantly changing physician reimbursement.
I noted that essentially every state that has physician fee schedules bases those fee schedules off Medicare – but while some are directly connected, most don’t simply adopt CMS’ changes but go through a process to modify them. Some states haven’t revised their schedules in several years.
That said, when Medicare changes reimbursement, it will affect comp over time.
The most likely scenario is an increase in reimbursement for cognitive services including office visits, a cut in pay for procedures including surgery and a big drop in imaging.
Greg Krohm provided a synopsis of the current Baucus bill, with the trenchant observation that it assumes the 21.5 pct cut will be implemented. In fact that’s part of the ‘cost savings’ the bill is supposed to deliver.
Todd Brown, one of the most knowledgable people I’ve met when it comes to state regulation of comp, gave a lot more detail on state implementation of fee schedule changes; it’s lengthy, complex, and varies significantly from state to state.
I’d be remiss if I didn’t note the audience – for all the presentations – was engaged, curious, involved and very knowledgeable. Regulators are sometimes dismissed as unaware or unconcerned or worse. That certainly doesn’t apply to the folks at this meeting. The level if engagement was significantly higher than I’ve witnesses at most other conferences, a credit to both the organizers and attendees.