Workers’ Compensation and the Affordable Care Act

By Mark Noonan | November 17, 2014

The Affordable Care Act (ACA) has been the law of the land for less than a year and the buzz is far from beginning to quiet.

The overall impact of the ACA on those citizens who did not have healthcare seems to be obvious: they will now have healthcare available to them and it is suspected (but not yet verified) that they will use their access to healthcare to improve their health and maintain wellness.

How the ACA could impact workers’ compensation is not yet known, but the potential is real.

Provider shortages in some areas are most often identified as an area of concern. Projected solutions are being considered, but the differences between general healthcare and the state-mandated benefits provided under workers’ compensation will cause challenges.

Nurse practitioners and physician’s assistants must continue to be part of the standard healthcare delivery model.

Provider Shortages

The reality in 2014 is:

  • 55 million Americans live in areas with an inadequate supply of primary care doctors;
  • With 30 million people moving from uninsured to insured, waiting times will increase by roughly 50 percent (according to a recent report “The Potential Ramifications of the Patient Protection and Affordable Care Act (ACA) on Workers’ Compensation” by attorneys Elizabeth Luzuriaga and Brian McElreath for the National Shipbuilding Research Program); and
  • Claims professionals acknowledge that the first 90 days of a claim define the course for the claim, but obstacles to timely initiation of a proper course of treatment will slow workers’ ability to recover and return to work.

So what can be done to help? The use of either nurse practitioners (NPs) or physician’s assistants (PAs) will provide needed depth to providers who may not have access to sufficient numbers of physicians to meet the treatment needs of their patient population.

Workers’ Comp Providers

Workers’ compensation is a state-mandated benefit with a different insuring philosophy. Unlike non-occupational health insurance which is constantly changing what it defines as appropriate methods of care to meet the innovations created by healthcare institutions and its professionals, workers’ compensation is reactive and slow in moving toward new methods of dealing with traditional problems.

Workers’ comp regulations do not indicate that the treating provider can be a nurse practitioner or physician’s assistant. Some in the industry believe this to be a worrisome trend, not because a PA and/or NP isn’t an acceptable standard of care, but because employers and insurance carriers don’t perceive that this treatment should rate the same reimbursement level as for a physician.

Healthcare providers often bill follow-up appointments with specialists and physician’s assistants at the same rate as a primary care specialist, according to the report “The Potential Ramifications of the Patient Protection and Affordable Care Act (ACA) on Workers’ Compensation.”

The shortage of doctors and nurses means that PAs and NPs must continue to become part of the standard healthcare delivery model. Having knowledgeable and professional caregivers for employees injured at work is the focus of enlightened employers. To discourage the use of NPs and PAs, without an adequate source of new physicians for the system, will result in a failure to provide assistance to those in need at a critical point in their lives.

Topics Workers' Compensation Talent

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Insurance Journal Magazine November 17, 2014
November 17, 2014
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