Today we begin with a plea for…research.
Can someone please provide evidence – that’s solid, well-documented, and not just opinion based on…common knowledge that employees file lots of claims under work comp that SHOULD be considered non-occ?
Or that Obamacare will lead to MORE claim-shifting to work comp?
because that’s what two recent analyses of Obamacare’s impact on P&C/work comp say. One, from Marsh, says “Employers have long been concerned that injuries from non-work-related causes will be shifted to workers’ compensation.” Why? Is there any basis for this “concern”? Any research? Science? Data? Not disagreeing with Marsh’s conclusions, rather challenging what passes for “accepted wisdom” in our industry.
Another “analysis” of Obamacare and P&C, by the Insurance Research Council, reads “In some cases, the [workers’ comp] claim may be legitimate, but would have been previously filed as a health-insurance claim…While increased cost-sharing may decrease health insurer outlays, it also may encourage individuals with health insurance to assert coverage for injuries under property-casualty insurance where the opportunity is present to do so.”
Again, since when is idle speculation “research”? And the assertion that there is “increased cost-sharing” is just ludicrous. In fact, there is LESS cost-sharing in many plans due to lower deductibles and co-pays under PPACA plans than employees’ previous health insurance coverage. Research indicates that if the annual out-of-pocket caps had been in place in 2011, the 15 million people who exceeded the cap would have saved $25 billion.
Truth be told, I too “knew” employees abused work comp, until it turned out the research indicated it wasn’t.
Then again, I’m not a “research council”…I am, however, a big believer in credible research and analytics and science.
A guest post on Monday will dig in to this deeply, so here’s the teaser. A Kaiser Health Tracking poll just released finds “those who are most likely to be customers in the Affordable Care Act (ACA)’s new insurance exchanges (the uninsured and those who purchase their own coverage) are more likely [54% to 34%] to prefer less costly plans with narrow networks over more expensive plans with broader networks.” (emphasis added).
Not surprising; those who have to pay the entire cost are more price-sensitive than those whose employers’ subsidize their premiums.
Hospital inpatient volume is declining
And has been for five years, due to fewer elective admissions, tighter controls by health plans, more use of outpatient rather than inpatient facilities, and the structural shift towards “fee-for-value away from fee-for-service” due to more emphasis on prevention and practice care.
Sounds good right? Sure, unless you are a P&C payer – as patient census counts from governmental and private insurers declines, those smart hospital execs are going to look for ways to make up that shortfall.
Then again, it’s not bad news for we taxpayers, as the decline has reduced Medicare spend below projections, which has helped give us the smallest deficit since 2008.
Always good to end on a high note!