In the wake of the healthcare-reform law, cost shifting ofnon-work-related injuries to the workers' compensation remains apotential issue, and potential stress on the healthcare systemcould lead to delays and drive workers' comp costs up, says brokerMarsh in a briefing.

But the law's focus on improvements in standards of care couldreduce the use of costly procedures that produce questionableresults, and employers could see premium refunds if they maintainbetter-than-expected performance in their healthcare programs,Marsh says.

In its analysis, “Health Care Reform and Workers' CompensationPrograms,” Marsh says, “Employers have long been concerned thatinjuries from non-work-related causes will be shifted to workers'compensation” due to higher reimbursement rates for medicalproviders and the lack of deductibles and co-payments foremployees. While some speculated that the greater access to healthinsurance under the Affordable Care Act would reduce cost shiftingto workers' comp, Marsh says it has “become clear that the law willnot result in all Americans having health-insurance coverage.”

One-in-ten large companies plan to cut back on hours for atleast a portion of their workforce to avoid providing coverage foremployees working 30 or more hours per week, Marsh points out,citing a Mercer survey, while other employers are using higherco-payment and deductibles to help offset cost increases. “Itappears, therefore, that the financial incentive for employees toshift treatment toward workers' compensation will continue underthe ACA,” Marsh says.

Regarding access to care, Marsh notes that the law is designedto increase the number of individuals in the U.S. with healthinsurance, which “could put additional stress on a healthcaresystem that is already short on doctors.”

Marsh says this could particularly impact specialists, leadingto delays in obtaining diagnostic tests and scheduling electivesurgeries and other procedures. “Longer periods of disability andcomplications as a result of such delays would ultimately driveworkers' compensation costs up,” says Marsh.

Employers, therefore, must develop medical networks “that focuson quality of care and outcomes—even if it means paying more on afee-for-service basis.”

While the healthcare industry has traditionally focused onvolume—more patient admissions, tests and procedures to drivehigher revenues—Marsh notes that post-reform, the industry hasshifted focus to improving standards of care and achieving betterpatient outcomes. Marsh says, “If this transition results inless emphasis on costly procedures, which often producequestionable results, workers' compensation costs could bereduced.”

The law also “provides for insurers to rebate premiums toemployers that have better-than-expected performance with theirhealthcare programs,” says Marsh, which employers can either passon to workers or use to offset future premiums.

Marsh warns though, that the National Council on CompensationInsurance (NCCI) has already “indicated that if premium refunds aregiven to employees, this would be considered payroll under theworkers' compensation premium calculations.” As workers' comppremiums are tied to payroll, costs could rise for employers thatpass the refunds on to workers.