Time From Injury to Treatment in Workers Compensation: Setting a Baseline to Monitor the Affordable Care Act

Posted Date: January 11, 2016
    

There continues to be uncertainty regarding the impact of the Affordable Care Act (ACA) on the workers compensation system. One question that is regularly asked is whether or not the ACA will overwhelm the healthcare delivery system and make it more difficult for workers compensation (WC) claimants to obtain needed medical care.

If the ACA, or other changes to US healthcare delivery, makes access to care more difficult, time from injury to first medical treatment may grow from the time the major provisions of the ACA took effect on January 1, 2014.

This initial report looks at the “baseline” time to treatment for WC cases before January 1, 2014.

Purpose

Determining the distribution of waiting times to receive various types of medical services, or to be treated by various types of medical professionals, may help policymakers better understand how changes in the healthcare system impact WC claimants’ access to care.

Conclusions

In general terms, the study indicates that the healthcare system currently has sufficient capacity reserve so that provider availability plays a secondary role to claimant behavior in driving the time to treatment. One takeaway from this is how, in a changing healthcare environment, educating workers about accessing the WC system becomes increasingly important.

The study also shows that the use of provider networks can influence the timing of care, especially toward making use of physical and occupational therapy sooner. Conversely, looking at office visits and arthroscopies, we found no relationship between higher reimbursement levels and a shorter time to begin treatment. Future studies may help determine the impact of an increase in the number of patients on the ability of the healthcare system to handle the caseload.

This investigation also shows that claimant age and gender as well as nature of injury affect time to treatment. And research is ongoing on building models for time to treatment that control for injury mix and claimant demographics.