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Workers compensation experts fear higher costs as health care reform kicks in

Workers compensation experts fear higher costs as health care reform kicks in

While the rollout of federal health care reform is still in its early stages, workers compensation experts are concerned that the Patient Protection and Affordable Care Act could increase patient demand for medical treatment, making it more difficult for injured workers to get the care they need and potentially increasing medical costs.

Though some portions of health care reform could prove beneficial to workers comp claims — such as providing health coverage to treat comorbid health conditions that often increase workers comp medical costs — observers say they're predicting lengthened treatment and return-to-work timelines for injured workers.

“If they can't get treated, that means you're going to continue to pay their salary continuation benefits ... so that could be an effect,” said Paul Braun, managing director of casualty claims for Aon Global Risk Consulting in Los Angeles.

“If I could have gotten back to work in one month, and now it takes two months or three months, that cost comes out of workers comp,” said Marc Gallo, principal in the financial services advisory practice at PricewaterhouseCoopers L.L.P. in San Francisco.

Observers say they expect an uptick in medical service utilization once previously uninsured people begin receiving health care coverage under the Affordable Care Act.

A white paper published by Travelers Cos. Inc. in January predicted a 15% hike in demand for health care services, based on an increased number of patients insured under the ACA.


Harry Shuford, chief economist for the National Council on Compensation Insurance Inc. in Boca Raton, Fla., expects that increased demand is likely going to be placed on specialists, such as orthopedic surgeons, since new insurance coverage would allow previously uninsured patients to receive surgeries or procedures they couldn't afford before.

Specialists booked with new patients could have difficulty making time to see workers comp claimants, Mr. Shuford said.

“It would be not so much primary care physicians, because I think for really significant injuries, the injured worker is going to go to the emergency (room) anyway,” Mr. Shuford said.

Increased demand for a limited supply of doctors could drive higher prices for workers comp medical care, particularly in states that don't have workers comp fee schedules to set pricing, Mr. Gallo said.

“There can be price controls and measures in place to affect that, but (increased demand has) got to come out (of) somewhere,” Mr. Gallo said.

Despite concerns about delayed treatment, experts say they expect workers comp to see some cost savings and other positive developments from reforms under the Affordable Care Act.

A report released early this month by Santa Monica, Calif.-based RAND Corp. estimates the Affordable Care Act could decrease workers comp costs by 1.4%, or $930 million overall.


That's based largely on a reduction in patients using workers comp to obtain treatment for health conditions that normally would be covered under group health plans, as well as lowered rates for workers comp fee schedule pricing in states where comp fees are tied to Medicare reimbursement rates.

Mike Farrand, Radnor, Pa.-based national technical director for workers comp medical cost containment at Willis North America Inc., said it's possible that injured workers who previously didn't have group health insurance would be more likely to receive preventive care and develop a relationship with a treating physician under the Affordable Care Act.

In turn, Mr. Farrand said, that could prompt an injured worker to visit their usual doctor rather than go to an emergency room after a minor work accident.

“There's a huge cost benefit there, if that truly happens,” Mr. Farrand said.