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The impact of the ACA on workers’ compensation

Learn more: Click above for additional Sedgwick perspective on the ACA in our Foresight for '14 or watch our Foresight for '14 video at

The Affordable Care Act (ACA) is bringing many changes to the healthcare system in America – and some of the same changes will affect the workers' compensation industry. With millions of newly insured individuals joining the healthcare system as a result of the ACA, access to care for workplace injuries is a major concern. Hospital consolidations have been on the rise, which can impact the availability of occupational treatment facilities and claim costs. Expanded provider options, new technology and a patient-centered healthcare model may help ensure injured employees continue to receive the care they need to recover and return to work.

Whether patients need treatment for occupational or non-occupational injuries, the reforms in the ACA could impact their access to care in nearly every state. This interactive map from the Kaiser Family Foundation shows how the ACA could decrease the number of uninsured individuals and increase Medicaid enrollment in each state.

Primary care physicians are often the first to treat workers' compensation injuries. Workers' compensation regulations in many states do not indicate that the treating provider can be a nurse practitioner or physician's assistant. With the shortage of doctors and nurses, physician assistants and nurse practitioners may continue to become part of the standard healthcare delivery model.

According to the Health Resources and Services Administration (HRSA), at least 55 million Americans live in areas with an inadequate supply of primary care doctors (source: The PEW Charitable Trusts). Some states have adopted rules that allow physicians' assistants and nurse practitioners to treat certain types of workers' compensation injuries. Here are a few examples:

  • California allows nurse practitioners to cosign a first report of injury and authorize up to three days of time off from work for an occupational injury
  • In Montana, advanced practice registered nurses are included as providers for workers' compensation, and in Ohio, workers' compensation continues to reimburse CNPs, Certified Registered Nurse Anesthetists and clinical nurse specialists
  • Arizona allows nurse practitioners to authorize an injured employee's inability to work
  • In Oregon, nurse practitioners can provide compensable medical services and authorize temporary disability payments for 180 consecutive calendar days (source:

Another area that impacts our industry is the increasing number of consolidations among health systems, hospitals and physician organizations. When hospitals merge and the new system's leadership does not want to provide occupational health, that is one less hospital available to treat workers' compensation injuries. Even in the hospital systems that merge and retain occupational healthcare, fee schedules could be negatively impacted.

Major hospitals nationwide have been consolidating for the past several years, including two large hospital systems in Texas and three in Michigan. Large mergers are also expected in California, Connecticut, Massachusetts, Rhode Island and other states. Consulting firm Booz & Company predicts that 1,000 of the nation's roughly 5,000 hospitals could seek out mergers in the next five to seven years.

Healthcare today is focused on engaging the consumer, driving quality, improving costs and ensuring access to healthcare for all Americans. Some health plans and health systems are creating accountable care organizations that strive to meet all of these objectives, while others address their end-to-end services with patient-centered healthcare models. Technology plays a significant role by connecting payers, providers, patients, caregivers and health systems – and eliminating silos. Connected health maximizes healthcare resources with programs such as telehealth and remote care. These options provide flexible opportunities for consumers to engage with clinicians and better self-manage their care outside the hospital or doctor's office. Care providers are connected with patients and key programs, which allows them to deliver quality, cost-effective, efficient medical care.

Bottom line – connected health is designed to help patients become healthier and more engaged in their healthcare decisions. With the various reforms in the ACA, a patient-centered model may help the healthcare industry ensure patients with occupational and non-occupational injuries and illnesses receive the care they need in the months and years ahead.

As we continue to address healthcare reform in future blog posts, I invite you to join the discussion. Join my LinkedIn group – Transforming Healthcare for Tomorrow – and share your thoughts.

Kimberly George, SVP, Senior Healthcare Advisor

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