The Impact of Healthcare Reform on Treatment Practices

Although much is said about how the new healthcare law will impact workers’ compensation, little is said unequivocally. It is known  workers’ comp is not a part of the new law. 

 

According to “Managed Care Matters” and others, workers’ comp is not, and will not be on any federal radar screen. The reasons are many, but primarily, the Workers’ comp industry is too small in terms of size and dollars to be of concern in the huge healthcare reform picture. Nevertheless, the new law will definitely impact doctors’ practices across the board. 

 

Healthcare reform is basically intended to provide treatment access and insurance coverage over a broad spectrum. On the surface, these are not relevant issues in workers’ comp. All employees are covered by their employers for workers’ comp and all employees injured on the job are guaranteed medical treatment by law.

 

However, the healthcare reform law will impact physician availability and accessibility and could impact injured worker treatment. Under healthcare reform, thirty million additional people now have the financial wherewithal to seek primary medical care. Given the current shortage of primary care doctors, how can accessibility improve?

 

Most discussions about the effects of the new law on workers’ comp center around employee utilization choices — whether they will use healthcare benefits as opposed to filing a workers’ comp claim. Answers to this question are speculative. This brief discussion is about how doctors will practice differently under the new law. Specifically, it will address how the new law impacts treatment of injured workers.

 

Even before healthcare reform, there were subtle shifts occurring in the general healthcare delivery landscape to be watched. One of these is the change in the settings in which physicians practice. U.S. doctors traditionally offered medical services from their private practices as individuals or in small groups. This “Dr. Marcus Welby” small office approach to delivering medical care is time-honored in this country. The arrangement offers accessibility, intimacy and builds trust between physician and patient. Many doctors continue to practice in this way, but a significant change has been noted.

 

A recent  New York Times article describes how an increasing number of doctors are giving up private practice to become employees of hospitals and healthcare systems. "As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, the Medical Group Management Association says. But within three years share dropped below 50%, and analysts say the slide continues."

 

While this trend away from private practice is not a result of the new healthcare law, its effects will be tangible because of it, along with the trickle-down effect on treatment of injured workers. The shift from traditional medical cottage industry to corporate medicine might come under the heading of unintended or unforeseen consequences of healthcare reform legislation.

 

Doctors are leaving their private practices for many reasons, but significantly among them are high operational costs. Individual or small practices are small businesses, entrepreneurial in nature, with typical small business issues — hiring, firing, training, marketing, payroll, billing, collections, regulatory compliance, and keeping pace with technology. Fixed cost overhead in a small practice can be staggering and is ostensibly a major impetus for the trend away from that form of medical practice.

 

The movement away from private practice and toward corporate medicine will be accelerated by healthcare reform. Reimbursement for Medicare and Medicaid is further reduced under the new law, making private practice even more difficult financially. As the benefit of autonomy found in private practice becomes more elusive, the trend away from private practice will gain momentum.

 

As doctors migrate to corporate medicine, working as employees of hospitals and healthcare systems, the nature of healthcare delivery will evolve. Working as employees, doctors will have limited scheduled hours, not the long overtime hours they worked as entrepreneurs, making the shortage more visible. Healthcare reform cannot guarantee accessibility when the number of primary care physicians is insufficient, regardless of the payment structure. Alternatives will come into play, such as greater use of nurse practitioners and physician assistants. Such alternatives might be a good solution from a cost standpoint.

 

It all begs the question, “How will these changes affect care for workers injured on the job?” The answer is occupational health clinics will continue as the best option wherever they are available. Occupational medicine clinics have doctors who specialize in treating workplace injuries and their accessibility will not be affected by the healthcare reform law. Outside of occupational medicine, doctors’ practice patterns for treating injured workers will be a question of accessibility and availability, probably with longer wait times for appointments and referrals. (workersxzcompxzkit)

 

The bottom line is doctors’ treating practices are changing and will continue to change with or without healthcare reform. Doctors working as employees of a corporation will follow corporate practice standards that define time spent with a patient, as well as time allocated to completing forms and communicating with families or employers. The silver lining for workers’ comp is those who can access occupational health specialists for injury treatment will notice no change. Accessibility and the quality of care should remain constant. As for those seeking injury treatment elsewhere in this new healthcare environment, the story could be different.

 

Author Karen Wolfe, BSN, MA, MBA. Karen is founder and president of MedMetrics, LLC, an Internet-based workers’ compensation medical analytics company. She applies her medical knowledge to gathering, understanding and applying workers’ compensation data to the operational process.  MedMetrics imports, integrates, and analyzes its clients’ medical billing and claims level data. MedMetrics uses several tools such as Predictive Intelligence Profiling and Medical Provider Performance Assessment to gather and analyze data. Contact: Phone: 541-390-1680; Karenwolfe@medmetrics.org; www.medmetrics.org.