Healthcare reform – Implications for work comp, Part 2

We’re all suffering from repeal-and-replace exhaustion, so I’ll keep this light and entertaining.  Or at least try to.

Quick – Is work comp the lion or the gazelle?

With ACA very likely to remain the law of the land, here are the over-arching implications for workers’ comp:

• Growing cost pressure on providers from group health and governmental payers will make those providers increasingly look to work comp to replace “lost income”
• Healthier workers will heal faster and need fewer healthcare services

Revenue maximization is the industry term for getting as much revenue from each patient as possible.  This entails:

• using the hospital “chargemaster” to set prices to drive higher reimbursement;
• using sophisticated software to avoid service denials or rejections;
• finagling codes to get higher reimbursement; and
• focusing on specific niches among many other tools/processes/approaches.

Rest assured work comp is one of the payers in the cross-hairs of “revenue maximizers”.

Next, as those with coverage likely won’t lose it, and we may see even more folks covered if other states adopt Medicaid as we discussed yesterday, the good news is

• more workers have health insurance,
• their health status tends to be higher,
• they are healthier, will tend to heal faster, and
• work comp won’t have to pay for their non-occ medical conditions if/when they do get hurt on the job.

Can we quantify this?  Not yet, but the research clearly indicates health reform has been good for comp.

As providers adopt new revenue maximization approaches, will work comp be able to keep them at bay?

What does this mean for you?

Which gazelle will you be – the one resting in the lion’s jaws, or his slightly faster brother?