By Jill Harris, Senior Vice President, Network Operations, Coventry
For years, the patient-to-provider ratio in the U.S. has continued to grow as an increasing aging population and decreasing provider pool has created a significant health care shortage crisis. Now, the pandemic’s toll on clinicians has exacerbated the situation. As a result, the workers’ compensation industry will need to look for innovative ways to ensure those hurt at work maintain access to timely, quality care.
The numbers illustrate the scope of the challenge. The Association of American Medical Colleges (AAMC) estimates in just 12 years, the U.S. shortage of primary and specialty care physicians could grow as high as 124,000. This is expected to occur as the population of Americans over age 65 will outnumber those under 18 for the first time ever. And, as the nation’s population ages, demand for care increases.
Hospital Strain and Staff Burnout
This has left many health care professionals overworked. At the end of 2021, about 40–70% acknowledged they were experiencing burnout, a significant increase from pre-pandemic rates, which averaged around 30–50%, an already alarming range.
Now, as the Omicron variant continues to spread through the country, the health care system is under even more strain, with about a quarter of the nation’s hospitals reporting staffing shortages in early January due to the virus. In addition to pandemic-related absences, many providers are also retiring. AAMC estimates in the next decade, more than two in five physicians in the U.S. will be aged 65 or older, leaving fewer medical professionals available to fill the gaps. As more providers leave due to age, the pandemic or other factors, those left could be more susceptible to burnout because of the resulting increased demand for services.
Access to Care for Injured Employees
The ongoing provider shortage, combined with the pandemic, has already begun to affect injured employees’ ability to access care. In the short term, as hospitals continue to be overwhelmed due to Omicron, some non-urgent or elective procedures, appointments and other services are again being postponed. This is similar to what America witnessed at the beginning of the pandemic; it’s a way to free up staff to treat COVID patients. This phenomenon isn’t isolated solely to the current surge — delayed treatments could be an ongoing issue if new variants continue to circulate.
Even beyond the pandemic, the workers’ compensation industry may face significant issues getting injured employees the treatments they need, which would harm patient outcomes and return-to-work timelines.
New Provider Types for Workers’ Compensation
To help meet the demand for care and prevent treatment delays, many states have begun allowing other providers, like chiropractic assistants, to bill for workers’ compensation. Some jurisdictions have also expanded the rules allowing more flexibility for certain provider types. For example, a few states have updated policies for nurse practitioners and physician assistants allowing them to bill directly instead of through a supervising physician. In other cases, nurse practitioners and physician assistants have also been given permission to sign documents on their own.
While these changes can help provide additional access to care for injured employees, they also raise new challenges that the workers’ compensation industry will need to address. These include issues related to precertification, billing, reimbursement and bill review systems.
Managing the Provider Shortage
As the provider shortage continues, there are a few areas the workers’ compensation industry should focus on to help mitigate some of the resulting challenges:
- Increase telemedicine use: A silver lining of the pandemic is that many jurisdictions have significantly expanded regulations related to telemedicine, which could be a practical way to improve access to care in locations where provider shortages are most acute.
- Expand use of provider networks: As physician demographics evolve, provider networks that expand with the regulations and demand for care will become a key resource to ensure injured employees have access to both timely and high-quality treatment options.
- Leverage care management staff: Case managers are specialists in directing injured employees to the right care at the right time. With knowledge and familiarity of local work comp experienced providers, who participate in the employer’s preferred network, they can help ensure claim continuity while delivering better care and cost outcomes.
- Ensure provider compliance: When regulations change, payers should look to their network partners to help educate providers about new updates and support them with the latest information to help them comply. This can improve efficiency which, in turn, can increase provider focus on patients and perhaps even reduce burnout.
Addressing these four areas allows the workers’ compensation industry to better manage provider shortage issues and ensure access to care, helping injured employees return to work and function.
About Jill Harris
Jill Harris is responsible for Coventry Auto and Workers Compensation provider network management, provider dispute resolution and direct network contracting. She has 27 years of experience in network management, contract negotiation, credentialing, training, acquisition management, and project and team leadership. Jill and her team are responsible for contracting with facilities, providers and ancillaries in support of our Coventry clients, provider legal and dispute resolution, overall network strategy and performance.
Enlyte is the parent brand of Mitchell | Genex | Coventry, a leader in cost-containment technology, independent medical exams (IME), provider and specialty networks, case management services, pharmacy benefit and disability management. The three businesses have recently aligned their joint industry expertise and advanced technology solutions into a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services.
Enlyte is a WorkCompWire ad partner.
This is NOT a paid placement.