Treatment Delays

Reimbursement Structure Overhaul Urgently Needed

An influx of new insureds is not the only risk that could delay the treatment of injured workers.
By: | March 13, 2014

Physician reimbursement is a larger risk to workers’ comp than the Patient Protection and Affordable Care Act’s potential to delay medical attention for injured workers, a health care economist warned.

WCRI_logoAfter Massachusetts implemented a 2006 health care reform law comparable to the ACA, wait times to see a doctor in the state increased from 47 days on average to 51 days, Jonathan Gruber told the Workers Comp Research Institute’s Annual Issues & Research Conference, held March 12-13 in Boston.

But the nation’s physician reimbursement structure incentivizes medical students to become specialists such as dermatologists, rather than primary care physicians, said Gruber, an economics professor at Massachusetts Institute of Technology, and director of the Health Care Program at the National Bureau of Economic Research.

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That is “a much bigger problem” for care delay than the potential for the ACA to increase wait times before patients see a doctor, Gruber said.

“We have a broken reimbursement system,” Gruber said. “We need to overhaul the way we reimburse doctors in this country and that is going to be incredibly hard.”

This year’s WCRI conference is focused on the ACA’s impact on workers’ comp and Gruber spoke on the future of the nation’s health care system under the ACA. But an audience member asked Gruber about the impact of millions more Americans obtaining health insurance under the law often referred to as “Obamacare.”

Some workers’ comp observers have expressed concern that as those Americans access medical care, patient congestion will slow injured worker treatment, delaying return-to-work times.

Gruber argues that Massachusetts’ reform model can help inform what will occur under the ACA.

“We have a broken reimbursement system. We need to overhaul the way we reimburse doctors in this country and that is going to be incredibly hard.”
— Jonathan Gruber, economics professor, MIT

Apart from Gruber’s presentation, a June 2013 report on patient access published by the Massachusetts Medical Society found shorter appointment wait times for patients seeing family medicine doctors. Wait days fell to 39 in 2013 from 45 days in 2012.

But wait times increased for new patients waiting to see specialists in internal medicine, orthopedic surgery, and pediatrics.

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Reforming state “scope and practice laws” is one means for helping reduce patient wait times, Gruber told the WCRI meeting. The laws mandate practices that must be carried out only by certain licensed professionals.

Changing those laws could free up doctors’ time, he said.

“There are a lot of things that doctors do today that do not have to be done by doctors,” Gruber said. “They can be done by physician assistants or registered nurses.”

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

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The R&I Editorial Team can be reached at [email protected]