"Although workers' comp may not be directly documented in the ACA, we will be impacted by accountable care," said Kimberly George, senior vice president and senior health care advisor for Sedgwick Claims Management Services.
"I believe if we include ourselves as an industry in the health care reform, we have an opportunity to help shape the quality of care for injured workers."
conversations with workers' comp practitioners, George
has found that some are taking a wait-and-see attitude while others are embracing the potential opportunities.
is urging the industry to understand, discuss, and create solutions in advance of the impact reform will have on workers' comp.
"There is one certainty with health reform; nobody knows what will happen," George
says the reform is aimed at improving the access to, quality of, and reimbursements for health care.
Those are areas where workers' comp practitioners should focus their energies to see how the reform can benefit the system.
"The access to care is not that physicians won't want to treat workers' comp patients.
We recognize it is highly reimbursed," George
"As a health care system evolves, it is a natural progression that nurse practitioners and physician assistants will have a greater role in primary care," George
"When I think of workers' comp specifically, will a payer or jurisdiction allow a nurse practitioner to be the primary provider?
We have to be cognizant as a system; if health care is moving in that direction, we have to as well."
Resisting such a change could likely result in poor outcomes for the workers' comp system, both financially and from the injured worker's perspective.
believes jurisdictions and payers need to get on board with expanding the field of primary care providers.
"Otherwise, they will be waiting for medical appointments that may extend out durations and potentially not provide quality care, so patients will have to wait," George
said."Every delay in workers' comp or disability impacts costs."
The quality of medical care in hospitals is likely to improve as the facilities try to avoid lost reimbursements.
explained, hospitals may be denied reimbursement for patients who are readmitted.
"Quality around nosocomial -- or hospital acquired infection, and [the desire to] send patients home in a safe way, as well as internal quality measures in hospitals will certainly be an improvement," George
said."So while the risks to quality and timely care occur from access, it could improve."
"They strive to implement quality measures to improve overall health care for the entire population they serve," George
said."An ACO seeks to provide patient-centered treatment programs and manage the continuum of care across the health care delivery system, which includes everything from wellness to chronic disease."
expects reimbursement systems of ACOs to have a big impact on the workers' comp system.
says the creation of ACOs and consolidation of medical facilities can be an opportunity to improve the quality of care for injured workers.
"Often today payers want to choose the services they have at different entities; pharmacy by one company, physical therapy from another, diagnostics obtained from yet another.
They may be selective where physicians can do the surgery," George