Who Will Pay for Occupational Health?

Denise Anderson

Denise Anderson , PA-C

Physician Assistant

Published August 03, 2012

Occupational health systems today are efficient. Patients are seen more quickly and procedures are more easily authorized in occupational settings than in most traditional medical offices. But under the Affordable Care Act (ACA), this may be about to change.

In the current version of health reform, there is less attention paid to occupational health than there was in the Clinton efforts back in 1993. The Clinton plan would have taken medical benefits out of workers’ compensation leaving only disability—a loss of 40% of funding for worker’ comp. That would have significantly impacted the program, which traditionally provides medical treatment as well as payment for work leave and rehabilitation services, and benefits for permanent impairment and death.

“This time around, there is no explicit reference to workers’ comp, which has brought the industry some relief,” Paul Mattera, Chief Public Affairs Officer at Liberty Mutual Insurance told Business Insurance in 2009. “We don’t feel the same sense of panic this time, although there’s deep concern, partly because it’s unclear how it will play out as far as workers’ compensation is concerned.”

Because workers’ compensation was not part of the discussion when Congress pass the ACA, occupational medicine was overlooked and, by default, left to the states. The effect of this could be challenging for workers’ comp programs.

Under ACA, we can expect the influx of large numbers of newly insured patients to swamp doctors’ offices and medical facilities. When this happens, it is likely that more people will file workers’ comp claims in an effort to get the care they need in a timely manner. This, in turn, will lead to crowding in occupational medicine and delays in treating workers’ comp-related problems.

At the same time that demand for workers’ comp services rises, there is a good chance that financial allocations to these programs will decrease. As of now, workers’ comp medical costs are only about 3% of overall US healthcare spending. That’s not a big portion. But when desperate states need additional money to fund Medicaid, treatment for the uninsured, and the new “exchanges,” what’s to stop them from raiding the workers’ comp piggy bank, under the rationale that workers no longer need to file workplace claims because they can get all the health care they need under ACA?

In such a situation, how will health care providers react? It seems likely that overcrowding and decreased re-imbursement will drive many of them out of occupational medicine, increasing the pressure on delivery of care.

So what can be done to save occupational medicine, and at the same time provide help to the broader healthcare system? To decrease the cost of occupational health programs, workplace prevention is the optimal solution. As of now, employers are required to fund ergonomic specialists and special ergo equipment, as well as “safety” measures mandated by OSHA regulations. We will need to find ways to create more powerful incentives for employers and reward them to fund expanded prevention programs. If workplace injuries can be prevented, this will ease the pressure on an oversubscribed and underfunded worker’ comp system, while also helping slow traffic into the Acute Care Continuum.

Partnering to improve patient lives

Vituity branding orange wave pattern background