‘Case Shift’ Under ACA Could Drive Up Calif.’s Workers’ Comp Costs
The Affordable Care Act could shift hundreds of millions of dollars in insurance claims from insurers to workers' compensation carriers, particularly in states like California that have high percentages of workers enrolled in HMO plans, according to a study released Tuesday by the Workers Compensation Research Institute, the San Francisco Business Times' "Bay Area BizTalk" reports.
According to WCRI President and CEO Richard Victor, researchers sought to determine whether financial incentives could "influence whether or not a case is determined to be work-related."
The study found that a back injury was up to 30% more likely to be labeled work-related -- and paid for through workers' compensation -- if the employee was insured via a capitated payment model, such as an accountable care organization.
According to WCRI, workers' compensation care is typically provided under fee-for-service payment models. The study noted that providers could be incentivized to categorize injuries or conditions as work-related -- particularly cases of which the cause is hard to determine, such as soft tissue or back injuries.
In California, a 3% shift of cases involving such "soft tissue conditions" from group plans could result in a $250 million increase in the state's workers' compensation costs.
The study noted that "case shifting" would particularly affect states with high percentages of workers enrolled in HMO plans. According to the report, California has the highest percentage of workers enrolled in such plans, at 42% (Rauber, "Bay Area BizTalk," San Francisco Business Times, 9/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.