There is no doubt that the political landscape has changed. The current administration intends to reduce waste, fraud, and abuse. Given the $40 trillion deficit, which continues to grow exponentially, every financial program funded by the federal government can be expected to be reduced. One of the most significant expenditures the federal government faces is Medicaid. Recent statistics note that more than 70 million Americans are covered and receive healthcare from the Medicaid protocols. The pending reductions in spending will clearly affect each of those individuals covered.
Some bloggers estimate that more than 11 million individuals with Medicaid coverage would lose their access to healthcare. Additionally, several hospitals, mostly rural, could see significant losses totaling more than $50 billion. The trickle-down effect is that these cuts will compromise those individuals who can least afford their healthcare.
A significant portion of those individuals who rely upon Medicaid for healthcare are members of the working class in this country. Quite frequently, the types of jobs those individuals hold put them at a more elevated risk of injury. Or, in some instances, the ordinary disease of life pathology identified under Medicaid coverage, continues to require treatment. Sometimes, attempts are made to correlate that particular pathology with an identified compensable incident.
Is Medicaid funding reduced?
It is only natural to presume that if Medicaid funding is reduced, or an individual loses coverage under the federally funded program, the need for care for the pathology noted does not abate. Frequently, attempts are made to outline that the noted pathology is a function of a specific compensable event. Then, the question becomes, what can one do to ensure that the only treatment rendered under the workers compensation scenario is a function of a specific compensable injury?
An additional consideration for any payer is what providers will do in response to this decrease in revenue. Pricing issues, excessive use of various services, and similar activities appear to be on the horizon. These individuals might attempt to find a way to utilize workers’ compensation to augment any reduction in revenues.
What does the Workers’ Compensation Statute Require?
The workers’ compensation statute requires that all care necessary to treat the compensable injury be provided. Therefore, it is incumbent upon those individuals managing that claim file to have a clear understanding of what pathology or specific clinical findings resulted from the reported mechanism of injury. A stubbed toe does not lead to a rotator cuff tear. Obtaining objective, independently confirmable, objective medical evidence establishing what is reasonable response to the noted injury and identifying all unrelated comorbidities within their individual injured employee is a key factor towards ensuring the standards outlined in the statute are met, and that expenditures are limited to the sequela of the compensable event.
Obtaining this clinical assessment of the medical records provided early in the life of this particular time, should not delay appropriate medical care, and in fact will expedite resolution of the determination of what the actual injury sustained so that all appropriate care can be initiated. Obtaining and reviewing all appropriate clinical information can only serve the interests of all stakeholders, including the injured employee, the employer, and the carrier.
The pending cuts to funding of Medicaid services will have an enormous ripple effect. Without a doubt, the objectified cuts will compromise worker’s compensation and healthcare delivery. There will be administrative challenges, and prompt early clinical evaluation of those records, utilizing the principles of evidence-based medicine will only serve to expedite the delivery of all care reasonably required to address the sequela of the compensable event.