Surgical Shenanigans: How Workers’ Compensation is being ripped off

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Now that I’ve cleared the air, and professed the faith of my conviction, I would like to get back to the subject at hand, which is implementing medical tourism into workers’ compensation. In my last post, I asked the following question:

Is there something different about patients who can afford to pay for medical treatment abroad or who have private health plans that do, from those who get injured on the job and have their treatment paid for by an employer or insurance carrier under workers’ comp?

In that same post, I also asked this question as well:

What difference is there if a person injures their hip or knee by engaging in some sort of physical activity outside of their employment, or if the person gets hurt on the job? Are the surgical procedures for these types of surgeries different for a working person than those for a middle-class or upper-middle-class person?

Well, according to a recent study just released by the Workers’ Compensation Research Institute (WCRI), and reported this week by WorkersCompensation.com, there is something different in what hospitals were paid for shoulder surgeries in workers’ compensation and what hospitals were paid by private or group health insurance for the very same surgeries.

The article, Hospitals Were Paid At Least $2,000 More For Common Surgeries For Injured Workers Than The Typical Patient, stated that in half of the study states, hospital outpatient payments for shoulder surgeries in workers’ compensation were at least $2,000 (or 43 %) higher than group health insurance.

The study, entitled Comparing Workers’ Compensation and Group Health Hospital Outpatient Payments, is the first, WorkersCompensation.com says, that compares hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation.

According to Richard Victor, the executive director of the WCRI, “These are large differences in costs in many states. Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers”.

The WCRI study also found that workers’ compensation payments exceeded group health payments by the most in states where the price regulations were based on a percentage of the hospital’s charges, or had no price regulation.

The study compared outpatient payments made by workers’ compensation and group health insurers for treatment of common surgical cases in 16 large states, which represents 60% of the workers’ compensation benefits paid in the US, and covers outpatient services delivered in 2008.

So apparently, there is a difference between workers’ compensation and group health insurance after all. The only problem is it does not have to do with the treatment received by patients covered under each type of insurance, but rather on how much workers’ compensation carriers paid hospitals for outpatient surgeries. Silly me, all this time I thought it had to do with the type of patient, now I see it has to do with the kind of insurance he is covered under.

So now, my question to the workers’ compensation industry is this:

How long are you going to put up with overpaying for the same surgical procedure for your workers’ compensation claimants, than what group health insurance pays for its patients for the same procedure under their plans?

And my question to the medical tourism industry is this:

If you claim that medical tourism destination hospitals offer lower cost health care than what is available in the US, then why are you not actively pursuing the workers’ compensation market, instead of just pursuing the private or group health care market? Do breast augmentations/reductions, plastic surgery and other common medical tourism procedures make more profit than that of the US workers’ compensation industry, or is it a lack of vision thing?

Do I have to spell it out every time I write an article? The American health care system (and that includes workers’ compensation) is too expensive. Yes, I know there are regulatory differences between health care and workers’ compensation. Yes, I know that in certain cases, there may be different processes involved with the same type of surgery for different patients. And yes, I realize that there are risk and complications; but really, what difference does it make if the patient was injured on the job and needs shoulder surgery, or if the patient was a weekend warrior playing hoops, football, baseball, or a myriad other sports and activities and needs  the same type of surgery? Not much.

The only difference is who pays, and how much, and based on this latest study, it seems the workers’ compensation industry is being hosed, big time. Time to wake up and explore the alternatives to high cost medical care for injured workers. Time to wake up and realize that the rest of the world is catching up to the “good ole’ USA” and providing better quality health care at lower cost.

I am not saying that it will be easy to implement medical tourism, so no one should think reading this that this is what I am advocating. And I am not saying that every destination is up to the task of providing such services. Far from it, but those that can, should be explored. Those that would like to in the future should be encouraged to seek out workers’ compensation carriers, third party administrators and case management firms here in the US for their advice and guidance.

The workers’ compensation industry can take the next step and seriously consider medical tourism, or it can continue to pay at least $2,000 more for the same surgery a group health plan pays. It’s your choice.

This entry was posted in Medical Tourism and tagged , , , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

4 thoughts on “Surgical Shenanigans: How Workers’ Compensation is being ripped off

  1. santhi@medicalsea.org

    <td style="text-align: left; background-repeat: no-repeat;" align="left"; height="113" colspan="1" background="cid:top@e2a37bc3e3dface9280ece520e9df6c4"Thank you Richard,  I have asked Calvin to post it - regardsSanthi NairEditorial & Marketing & PublicationE: santhi@medicalsea.orgT: +6017 311 3843http://www.medicalsea.orgSkype : santhi.nair1SEA Media & CommunicationsG-6-5 PelangiDamansara Condo, PJU 6, PersiaranSurian,47800 Petaling Jaya, Selangor, Malaysia[RegNo : 002155136-U]

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  2. Pingback: Surgical Shenanigans: How Workers’ Compensation is being ripped off | Welcome to Medical- South East Asia, News Focusing on Medical Devices | Medical Tourism | Hospital Services and more

  3. richardkrasner Post author

    For those of you in the workers’ compensation industry, here is an article that purports to tell you how to deal with the higher costs of surgery under work comp compared to what group health pays. The author is suggesting that legitimate wc claims should be filed as group health claims instead. Another quoted individual suggests negotiation as a tactic, but that’s like negotiating a $50,000 surgical bill that is probably $48,000 under group health, given the $2,000 figure of the WCRI report, down to $45,000, when it probably can be gotten in a medical tourism destination for between $10,000 and $17,000, depending upon the medical tourism destination. (This is just an estimate based on figures I have seen or heard of)

    Here is the article from the CFO blog:http://www3.cfo.com/article/2013/6/risk-management_workers-compensation-group-health-insurance-wcri-fee-schedules-?goback=%2Egde_80614_member_252629068

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