Insight, analysis & opinion from Joe Paduda

< Back to Home

Sep
27

Work comp and national health reform – damned whether we do or don’t

Work comp’s medical spend is about 1/100th of total US medical spend.

So we don’t control healthcare, healthcare controls us.

Sure, there are work comp rules and regulations, laws and courts, but medical providers are far more interested in and aware of what Medicare/Medicaid/Private insurance wants/demands/does than all-but-insignificant work comp.

Well, that’s not exactly true – providers are getting ever smarter about how to profit from work comp.

The US health care system needs major reform – covering most/all of us, forcing providers to reduce the cost of care and cost per person, and improving the health of all of us.

I believe we’ll see major national health reform by 2025; others think I’m nuts. (we may both be right!)

If reform happens – or doesn’t – work comp will be affected. Here’s why.

Over the very near term, let’s assume the ACA dies when the Republican Attorneys General win their Texas lawsuit.

The next day – or darn close to it – the legal basis for our healthcare delivery and reimbursement system could be effectively gone. What will providers and insurers do?

Most health insurers will do everything they can to roll back protections for insureds, limit coverage, and tighten provider networks, because they’ll make a lot more profit doing that.

Then, providers will find their patients are increasingly under-insured, or their conditions aren’t covered, or the treatment they prescribe isn’t allowed.

In comes Fred Flintstone with a mushed foot suffered when he dropped a boulder on it, and voila! Provider problem solved…thank you workers’ comp.

The result – workers’ comp may well see higher medical costs from revenue maximizing providers suffering under lower reimbursement and more uninsured care.

If I’m right about national health reform and massive reform does occur, its highly unlikely work comp will be included in that reform. Without much stronger regulatory protection such as a universal all-payer fee schedule, savvy providers will increasingly target work comp as we’re woefully unable to stop sophisticated schemes to suck more dollars out of workers’ comp payers.

The result – workers’ comp may well see higher medical costs from revenue maximizing providers suffering under lower reimbursement and more uninsured care.

What does this mean for you?

Prepare. 


One thought on “Work comp and national health reform – damned whether we do or don’t”

  1. You are probably correct in your wrap up: lower reimbursement and more uninsured care; loss of wages and inability to pay for family bills and necessities. Let’s hope reform is actually on its way.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL


 

SEARCH THIS SITE

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.

 

DISCLAIMER

© Joe Paduda 2019. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives