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Effects of health reform on workers comp sector masked by other factors

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Identifying the effects of the Patient Protection and Affordable Care Act on workers compensation systems is a challenge, with many factors influencing the time between injury and treatment, according to a new study released Monday by the National Council on Compensation Insurance Inc.

While “the ACA's near-term impact on how (workers comp) cases access medical care remains uncertain,” provider availability appears to play a secondary role to claimant behavior in driving the time to treatment, the Boca Raton, Florida-based workers comp ratings and research organization said in the study.

One factor that influences time to treatment for injured workers is the nature of the injury, according to the study, “Time from Injury to Treatment in Workers Compensation: Setting a Baseline to Monitor the Affordable Care Act.”

For workers comp trauma cases, including fractures, open wounds and burns, 63% are treated on the same day as the injury and 85% are treated within a three-day period after the injury, the study found. Meanwhile, 55% of all workers comp cases are treated on the same day as the injury and 80% are seen within three days.

“Some of the difference between trauma cases and all cases may be due to the increased ambiguity in assigning date of injury for the nontrauma cases,” said NCCI, noting that it can't measure the time from when care was initially sought to when it was first provided.

Gender is another factor included in the study, which states that injured male workers are treated sooner than injured female workers in trauma cases, as workers in more risky occupations are predominantly male.

For example, 30% of male injuries are for “relatively quicker-to-treat open wounds” compared with 19% of female injuries, according to the study. And 27% of male injuries are for “relatively slower-to-treat strains and sprains” compared with 35% of female injuries.

The type of health care provider also plays a role, as injured workers who see a network physical or occupational therapist on the first date of service start their therapy “somewhat sooner … suggesting perhaps that in-network providers put a higher priority on a timely recovery of function,” according to the study.

“Given all the influences that interact and affect the time to treatment, it will be difficult — if even possible — to isolate the impact of the ACA,” NCCI said, adding that educating injured employees about accessing the workers comp system is increasingly important in a changing health care environment.

To conduct the study, NCCI looked at medical-only and lost time claims occurring between July 1, 2010, and Dec. 31, 2012, that had at least one medical treatment within 360 days of the date of injury.