Thursday, March 13, 2014
Workers compensation insurance will have to move quickly to keep from being a net loser from health care reform, said Dr. Jonathan Gruber, one of the architects of what ultimately became the template for the Affordable Care Act (ACA).
Dr. Gruber, an MIT economist who helped construct the Massachusetts health reform that the ACA modeled, spoke to more than 400 attendees at the Workers Compensation Research Institute (WCRI) conference in Boston.
Health care reform should help the workers compensation system, he said. Fewer workers will be uninsured, so fewer people will get injured over the weekend and then claim on Monday they got hurt at work.
But Dr. Gruber, an MIT economist, noted that the comp system is incredibly inefficient. It pays higher rates for services than most health plans. And it changes slowly, which could be a big disadvantage as the ACA forces efficiency on the other parts of the health care system – hospitals, doctors and health insurers. If the comp system canâ€™t keep up, the rest of the system will find ways to dump costs on it.
Dr. Gruber said it will be three years before we can tell whether ACA has been successful. At this point – in ACAâ€™s early days, its proponents and opponents are â€œsaying too much.â€
Gruber also gave a nod to researchers like those at WCRI. With ACAâ€™s many moving parts, he said, it will be important to intelligently determine which of those parts are truly working.
Day One of the WCRI conference also featured two examinations of how changes in state comp laws play out.
The first showed how Texas successfully reduced the rate of claims through changes enacted in 2002, 2003 and 2005. The changes brought individual claims under greater scrutiny.
The good news: the rate of claims in Texas lagged those of 15 states studied, said WCRI senior analyst Carol Telles. The rate of claims from chiropractors fell more sharply than other professional services, though Texans continue to use chiropractors more than the other states.
Costs per claim, though, increased, in part because the changes arenâ€™t free. It costs money to review claims. Any changes to a workers comp system must consider whether savings will be able to justify those costs.
The second study showed how Illinois took a more blunt approach in 2006. It cut fee schedules 30 percent across the board. One interesting result, said senior public policy analyst Rebecca Yang: costs per claim fell, as you might expect, but only by 24 percent overall.
Among the reasons: the rate of claims increased, and there were signs that doctors were billing for more complex office visits than before.
Day Two of the conference will take a longer look at the impact of ACA on workers comp. Other sessions will look at how the economy drives workers comp results; accountable care organizations; and medical dispute resolution.