ACA May Shift Claims to Work Comp: A Rebuttal

Back in September, I wrote a post that said a study by the Workers’ Comp Research Institute (WCRI) indicated that the ACA may shift claims to workers’ comp.

Last week, the WCRI held a webinar, which I attended, and along with the presentation by outgoing WCRI President and CEO Rick Victor, my fellow blogger, Joe Paduda, gave an opposing view.

According to Joe, “it’s very hard to attribute case-shifting to ACA) based on what I see as a very complex and diverse health care world.”

The reasons for Joe’s skepticism can be based on the following assumptions those who are making the case for case-shifting have expressed:

  • HMOs are capitated
  • there are financial incentives e.g. capitation at the primary care level
  • primary care providers are aware of the financial implications of case assignment
  • PCPs purposely assign cases to work comp based on those financials the ACA will lead to more Accountable Care Organizations that will use capitation more

To get deeper into Joe’s perspective on case-shifting, click on the following link to his blog post:

Here are the slides from the webinar:

WCRI Webinar Impact of the ACA on Claim Shifting Slides 12.10.15


This entry was posted in ACA, Affordable Care Act, Case-shifting, Claims, Medical Tourism, Medical Travel, WCRI, Workers' Comp, Workers' Compensation 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: Resume:

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