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Does the ACA cause providers to shift cases to work comp?

The ACA is in place and causing massive changes to the provider and payer landscape. One question broached by WCRi in recently-published research deals with the possibility of “case shifting” from group health to work comp.

That is, do primary care providers selectively “allocate” cases to work comp based on reimbursement motivations?

If yes, there are obvious and significant ramifications for all of us, many of which will have negative consequences for employers and insurers.

But, in my view, the picture is anything but clear – on many levels.

WCRI’s hosting a webinar this Thursday at 2 pm EST on the topic.  They have been kind enough to invite me to present a contrasting perspective.  There are already over 100 registrants, so the good folk from WCRi have opened up registration to accommodate the demand.

Sign up here.

Webinars are $39 for WCRI members; $79 for non-members; and no charge for members of the press, legislators as well as their staff, and state public officials who make policy decisions impacting their state’s workers’ compensation system.

See you there.

2 thoughts on “Does the ACA cause providers to shift cases to work comp?”

  1. Joe – I can’t make the call — but the question I would ask is, assuming cost shifting has always been an issue (which is clear to me — the first question asked by providers is if the injury happened at work) — have we seen evidence that ACA has had an impact on “increasing” the drive for cost-shifting?

  2. Yes, there will be an incentive, but we do not have any evidence of it yet in our data, nor do we have any anecdotal evidence. We need to remember though, there have always been numerous incentives to cost-shift. First of all, the provider doesn’t want to lose the case to the patient’s health plan provider, and second, the workers compensation reimbursement is often higher than it is for Medicare or the large health plans. From the patient’s perspective, we are all well aware of the incentives that they and their lawyers have to shift these costs.
    Now with the ACA, there will be even more pressure, and more reason to practice diligence on every claim.

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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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