Reform’s impact on workers comp; Part 2

Yesterday I highlighted four main ways health reform will impact workers comp. Today we’ll focus on the less-noticeable ways reform will change the comp industry. But we’ll start by addressing one of the common misconceptions; people without health insurance are more likely to file comp claims.
The research indicates the opposite is the case. As I’ve reported previously here (can’t link to the post cause I’m posting from my iPhone), a recent study documented the opposite; those with health insurance were more likely to file a comp claim than those without coverage. That appears to be more of a statistical than a causal link. There are other factors – e.g. the way the employer treats their workers, the workers’ pay level and immigration status, that appear to have more influence on filing than does coverage.
So don’t expect to see a decline in frequency due to broader health insurance coverage.
Medical devices
While the reform bill does include excise taxes on certain medical devices, it also promises to dramatically increase the number of potential customers for those devices. There has been some concern that manufacturers would raise prices to offset the new taxes; this remains a distinct possibility as there is little price elasticity in the device market. For comp
payers, there is the distinct possibility that device usage will increase driven by suppliers’ enthusiasm for new customers, a potential negative that may be offset by the suppliers’ focus on the much bigger employer and CMS (Medicare and Medicaid) health markets.
Medical management
What passes for medical management in the group and CMS world, while mostly ineffective, is nonetheless far more robust than what passes for med
management in work comp.
That isn’t likely to change anytime soon, but within the next couple of years I fully expect group insurers and health plans will invest heavily in medical management, data mining, analytics, chronic disease management, and electronic health record technology. This will help comp payers in two ways: as comp trails about a decade behind group, these new and improved med management tools will find their way into comp; and the improvements in patient health will reduce the need for comp payers to fix non-work-related medical conditions that complicate treatment of the comp injury.
Healthier claimants
Which brings us to what may well be the moat significant long-term impact of reform; the likelihood that workers will be healthier, their underlying conditions and comorbidities will be at least addressed by their health plan, and therefore comp payers won’t have to pay for treatment of those conditions in order to resolve the work injury. Think diabetes and surgery, spinal stenosis, and hypertension.
Degenerative conditions
Finally, for some diagnoses, identifying the cause of the injury is becoming increasingly problematic. It is often difficult for a physician to determine the ’cause’ of back pain or dysfunction; it may, or may not be wholly or partially related to a work injury and different physicians often reach different conclusions about the cause of injury. While reform won’t clear up those medical mysteries overnight, it will reduce the need for comp payers to pay for what are clearly non-work-related conditions.
What does this mean for you?
Opportunities for observant payers that quickly adopt innovations, and more need for COB expertise for claims staff.
Tomorrow – what’s coming next…how ‘fixing’ physician reimbursement will affect work comp.
Posted via iPhone.