WCRI’s annual meeting began with a presentation on the relationship of fee schedules to case shifting. Put another way, does physician compensation affect categorization of claims as work comp?
This followed their previous study (discussed here) on the impact of capitation on case shifting (kudos to WCRI for allowing me to present a different view in their webinar on the topic).
(note the report discussed herein is based on preliminary findings and subject to change)
The basic question addressed was “do higher fee schedules increase the number of workers’ comp cases?” More specifically, do treating docs categorize claims as work comp because they make more money under work comp?
The research looked at knee arthroscopies across a couple dozen states; there was some consistency in prices paid in those states for group health claims; notably several states had much higher reimbursement for work comp than group health (CT, IL, NJ are three).
Key finding – “A 20% growth in WC reimbursement rates for office visit related services equates to a 6% increase in the odds of a soft tissue injury being called work related.” [paraphrase, may not be exact quote]
In contrast, there was no difference in trauma-related cases, which implies providers
David Deitz, MD noted a key consideration not addressed – the microgeography of health care varies quite dramatically within states and may be an important driver; this may be a fruitful area for further investigation. (the Truven database doesn’t allow for this type of analysis) Dr Deitz also noted the American Academy of Orthopedic Surgeons evidently recommends physicians consider type of coverage when determining whether or not to perform surgery. (paraphrasing Dr Deitz)
Notably, patients may get significantly richer benefits if the claim is determined to be work comp due to indemnity benefits.
The researcher, Dr Olesya Fomenko, determined that two states in particular saw significant financial impact of this; there was a multi-million dollar impact in IL and TX due to the higher medical costs AND indemnity expense associated with the “higher number” of work comp cases due to case shifting.
A key question not addressed is this: how is the treating doc’s pay affected by the payer type? Not the overall reimbursement differential, but the payment to the doc who actually makes the causation determination.
There is a way out of this, but this industry is deaf, dumb and blind to the reality…less expensive surgeries with better quality and none of this case shifting by physicians.
With all the changes and challenges work comp is and will face in the future, not doing what I and others advocate is just plain crazy.
But go on attending the same old conferences and seeing the same old people peddle the same old, and useless solutions to rising medical costs.