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Live blogging from WCRI

In lovely Boston this week for the annual WCRI meeting, a day and a half stuffed with Research findings data and interpretation thereof.

Warning- due to some laptop issues I’ll be posting from my iPhone, and you will undoubtedly see many more typos than usual. A prize to the reader who correctly totals all the typos over the next two days.

The conference begins with the usual WCRI disclaimer that the organization presents research results and does not take policy positions. I’m happy to infer what the results mean and what we should do about the findings.

The lead off session addressed the impact of ppaca on work comp, specifically cost shifting from group to work comp.

Olesya Fomenko Ph.D did the research on the topic with a focus on ACOs and their impact on case shifting from group to comp. Much of the discussion revolved around capitated vs fee for service reimbursement and the financial motivations of the treating provider. In a capitated system, the doc gets paid the same amount for all non-occ care, but makes more for treating occupational conditions as they are not covered under he capitation arrangement.

The key finding is the “growing use of capitation is likely to increase the number of soft tissue injuries seeking payment under WC.”  Obviously this is going to be more common in states where capitated plans are more common.  The research indicates a potential increase in soft tissue claims in the 12 or so states with a quarter or more of workers covered by capitated plans – CA NY PA MI MA etc.

If capitation increases, there may well be more states with characteristics indicating a higher propensity to shift cases from group to comp. Capitation has declined over the last decade, but the growth of acos is likely reversing this trend.

Whats not visible in the data is the question “were soft tissue claims under reported previously, and now that there are stronger financial incentives to correctly categorize claims, they are now correctly categorized?”

2 thoughts on “Live blogging from WCRI”

  1. Counted none. You even have the punctuation inside the quotation marks! Way to go, and thanks for the insight.


  2. Joe, just to be clear, if a provider bills the WC carrier for treatment of any type of injury, it still must pass the “smell” test that it is compensable. If the shifting of billing is going on then I can only surmise two possibilities. 1) The treatment was for a work related injury but the “patient” used his health insurer instead of the WC insurer, or 2) there is a slew of unreported injuries to the employer/insurer.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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