Transcript Legal Barriers to Implementing International Providers into Medical

Barriers, Obstacles, Opportunities
and Pitfalls of Implementing
Medical Tourism into Workers’
Compensation
Richard Krasner, MA, MHA
Blogger-in-Chief
Transforming Workers’ Comp Blog
Introduction
Legal Barriers to Implementing International
Providers into Medical Provider Networks for
Workers’ Compensation
Merrell: “…Can you see a role of medical tourism in workers’ compensation
injury?”
Ludwick: “I could, if it were a long-term issue. Many workers’ comp issues
are emergent, so that would take out the medical tourism aspect. However,
if it was a long-range issue, I could see us involving workmen’s comp issues
into that, or problems.”
Lazzaro: “I would support that. I don’t know the incidence, for example, of
some of the orthopedic procedures that are non-emergent, such as knee or
hip replacement, which would fall under workmen’s comp. But theoretically,
a case could be made for that…”
Merrell: “I was thinking about it in terms of the chronic back injury and the
repetitive action injuries and hernia that are in the workers’ compensation
area. An acute injury on the job would probably not be at issue but a workassociated problem with a potentially surgical solution might be a matter for
medical tourism.”
Source: Ronald C. Merrell, et al., Roundtable Discussion, Medical Tourism, Telemedicine and e-Health, (January/February 2008), 16,
http://www.lieberonline.com/doi/pdf/10.1089/tmi.2008.9995
Merrell: “…Can you see a role of medical tourism in workers’ compensation injury?”
Ludwick: “I could, if it were a long-term issue. Many workers’ comp issues are emergent, so that would take out the medical tourism aspect. However, if it was a long-range issue, I could see
us involving workmen’s comp issues into that, or problems.”
Lazzaro: “I would support that. I don’t know the incidence, for example, of some of the orthopedic procedures that are non-emergent, such as knee or hip replacement, which would fall under
Average Medical Cost per Lost-time
WC Claim
 Average WC medical cost per lost time claim was
$26,000 in 2008 (6% increase from 2007)
 Medical costs in 2008 were 58% of all total claims
 40% of WC costs are associated with medical and
rehabilitative treatment
 In 1980’s & 1990’s, medical costs fluctuated, rose in
2000’s, and totaled $41.7 billion annually (as of 2002)
Source: Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation
https://app.box.com/s/77inqpo9pa91y6rxt133
Average Medical Cost per Lost-time
WC Claim, cont’d.
Source: NCCI
2012p – Preliminary figure based on data valued as of 12/31/2012
Average Medical Cost per Lost-time
WC Claim, cont’d.
Source: NCCI
2013p – Preliminary figure based on data valued as of 2/31/13
Barriers, Obstacles, and Pitfalls
State Regulations, Rules and
Statutes
“…aged statutes and old case law”
Licensing of Physicians — Medical providers must be
licensed in state to practice medicine
Treating doctors must be within 50 miles of claimant’s
home
Oregon and Washington state allow injured workers to go
out of state or out of the country with approval by state
Managed Care Networks — different states have different
rules for vetting and credentialing of physicians
Other Legal Barriers
Federal & State laws intended to protect consumers,
instead increase costs and reduce convenience
Federal & State regulations restrict public providers
from outsourcing certain medical procedures
Federal STARK laws inhibit collaboration
State licensing laws prevent certain medical tasks
being performed by providers in other countries
Foreign physicians lack authority to order tests,
initiate therapies, and prescribe drugs US pharmacies
can dispense
Source: Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation
https://app.box.com/s/77inqpo9pa91y6rxt133
Laws that have not caught up with
the times
Illegal for physician to consult with patient online
without initial face-to-face meeting
Illegal for physician outside the state and has
examined patient in person to continue treating via
Internet after patient goes home
Illegal (in most states) for physician outside that
state to consult by phone with the patient residing in
that state if physician is not licensed to practice there
Source: Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation
https://app.box.com/s/77inqpo9pa91y6rxt133
Lawyers, the Courts, and WC Boards
Plaintiff — if employer/carrier chooses to offer medical
tourism as option, lawyer may tell client to refuse or
challenge employer/carrier
Defense — if employee chooses to go abroad, carrier or
employer’s attorney may say no
Administrative Law Judges (ALJ), Workers’ Comp Boards
(WCB) and Commissions may not allow medical tourism
State courts will not authorize surgery abroad
Politicians, Health Laws, & Misc.
 State Legislators
 Medical Malpractice, Liability, patient privacy and medical
records laws (including HIPPAA, ERISA, and PPACA)
 Entrenched interest groups wishing to avoid competition
with low-cost providers
 Other vested interest groups, such as Claims Adjusters,
Insurers, Third Party Administrator’s staff (including
Medical Directors), Local Physicians and Hospitals, etc.
 Lack of knowledge about quality of medical care abroad
(“Third World medicine”)
 American attitudes towards medical care abroad
(Resistance is Futile!) and “American Exceptionalism”
Workers’ Compensation and other
issues
Opioid Abuse
Disability Ratings certifications – physicians must be
certified by each state to issue impairment ratings
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Temporary total disability (TTD)
Temporary partial disability (TPD)
Permanent partial disability (PPD)
Permanent total disability (PTD)
Maximum Medical Improvement (MMI)
Immigrants unaware of workers’ comp
Free trade agreements — do they help or hinder?
NAFTA
Opportunities
Workers’ Compensation
 Mexico — Cross-border Workers’ Comp in CA
Insurance Company of the West (ICW)
Writing WC policies for San Diego/Imperial Valley area
insured clients to provide cross-border work comp
Employers/Employees have option to choose Mexican
HMO SIMNSA (only HMO licensed in CA)
If employee is injured, sees CA primary physician, any
future treatment through SIMNSA, w/follow-up visits
on routine basis w/primary physician
Source: Cross-border Workers' Compensation a Reality in California
Mexico, cont’d.
 NAFTA and Workers’ Comp conflict
 Porteadores Del Noroeste S.A v. Industrial Commission of AZ
 April 2010, truck driver hauling diesel fuel from Phoenix to Nogales, Mexico,
fell asleep behind wheel, ejected from cab of truck, taken to hospital in
Nogales, then transferred to hospital in Tucson
 Driver requested determination of disability and benefits from Instituto
Mexicano del Seguro Social (IMSS), went outside of IMSS network, IMSS
refused to pay all his bills
 Driver filed claim under AZ work comp system seeking payment of $17,000
for care and additional compensation
 Sept 2010, filed injury report w/Industrial Commission of AZ
Source: Comunicación No Es Médicamente Necesario
http://daviddepaolo.blogspot.com/2014/06/comunicacion-no-es-medicamente-necesario.html
Mexico, cont’d
 NAFTA and Workers’ Comp conflict, cont’d.
 Employer argued ICA did not have jurisdiction because it was a foreign
company and its activities in US governed by NAFTA, not AZ work comp
law
 Administrative Law Judge decided subject matter jurisdiction over
claim existed, and determined accident was compensable under AZ law
 AZ legislature amended workers’ comp laws — workers who have a
claim in AZ and a claim in a foreign country for same injury are entitled
to full compensation which the worker is due under AZ law
 If the worker receives compensation in the other country, then
employer or carrier will be required to pay worker add’l compensation
Source: Comunicación No Es Médicamente Necesario
http://daviddepaolo.blogspot.com/2014/06/comunicacion-no-es-medicamente-necesario.html
Mexico, cont’d
 NAFTA and Workers’ Comp conflict, cont’d.
 New law did not apply to case, but opinion was in line w/new law
 Unanimous AZ Court of Appeals panel ruled Mexican firms sending
employees into US became subject to same work comp laws domestic
employers are subject to
 Court held that NAFTA did not pre-empt AZ work comp statutes and
that Porteadores could face liability in AZ for add’l compensation that
one of its workers claimed he was due
 Court said unambiguous language of NAFTA provides that only US can
challenge a state law as conflicting w/terms of the agreement between
US, Canada and Mexico
Source: Comunicación No Es Médicamente Necesario
http://daviddepaolo.blogspot.com/2014/06/comunicacion-no-es-medicamente-necesario.html
WC Statutes/Claims
Process/Insurance or Legal
Employee/Employer Choice of Physicians
 State WC laws recognizes 9 categories of choice:
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Employee choice of physician
Employer choice of physician
Employer/Carrier
From a list maintained by the employer
From a list prepared by the appropriate state agency
From a Panel
From Employer’s Managed Care Plan
From a PPO
Self Insured Employer
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Employee/Employer Choice, cont’d.
Source: WCRI , Workers’ Compensation Laws As of January 1, 2014, April 2014
Utilization Review
 Utilization Review: In WC, process by which an outside medical expert reviews
diagnosis and treatment to determine if proposed or completed treatment is
medically necessary. There are 3 types of utilization review:
 Pre-certification review: occurs before medical procedure or treatment is
provided
 Concurrent review: occurs during time medical treatment or service is
performed (e.g., a hospital stay)
 Retrospective review: occurs after service has been provided
 Completed by highly experienced nurses who review medical records and
determine if procedure is medically necessary
 Also verifies that there is a causal relationship between the procedure and the
injury
Source: http://blog.reduceyourworkerscomp.com/2013/09/what-is-utilization-review-in-workers-compensation/
Utilization Review, cont’d.
 Companies that provides UR must be certified by the Utilization Review
Accreditation Commission (URAC)
 URAC establishes standards throughout the medical field in the US for
UR
 URAC is an independent, nonprofit organization
 Main focus is domestic health care system, including workers’ comp
 Creating such an agency for medical tourism would require the
industry’s input and involvement, as well as every single government
health ministry in destination countries, as well as other international
organizations in the health care and medical tourism sphere, and all
other interested stakeholders
Source: http://blog.reduceyourworkerscomp.com/2013/09/what-is-utilization-review-in-workers-compensation/
Opt-out Programs
 In the US there are two types of workers’ compensation programs:
 Statutory Workers’ Compensation (Subscriber program)
 Voluntary or Non-subscriber (also called an opt-out program)
 Only two states currently allow employers to opt-out of statutory
workers’ compensation:
 Texas
 Oklahoma (signed into law May 2013)
 Oklahoma law allows employers to choose an alternative to statutory
WC system under certain circumstances, Texas only state where
participation is truly voluntary
Source: Opting Out of Texas Workers’ Comp Doesn’t Have to Mean Going Bare
Opt-out Programs, cont’d.
 Texas Model – Not a 50-50 proposition w/half opting in and other half opting out
– approximately 114,000 employers operate as nonsubscribers in Texas
 One-third of employers considered nonsubscribers: “when you opt-out of the
work comp system in TX you automatically become a ‘nonsubscriber’”
 Slight increase from 32% in 2010 to 33%.
 Types of businesses that non-subscribe are employers who have determined to
be in more control of their claims and take better care of their employees
through better medical management and physician outcomes
 Employers tend to be more engaged in administration of their program, putting
them closer to their employees and allows them to be more involved with the
claim and outcome
 Companies choose to non-subscribe because cost of statutory work comp too
high; if comp too expensive, they do one of two things: drop work comp or look
to non-subscription
Source: Opting Out of Texas Workers’ Comp Doesn’t Have to Mean Going Bare
Opt-out Programs, cont’d.
 Employers tend to be more engaged in administration of their program, putting them
closer to their employees and it allows them to be more involved with the claim and
outcome
 Employers have some control over whether medical providers are approved or not
approved to provide services and get more specialization and better doctors
 Industry sectors with highest percentage of non-subscribing employers:
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Arts/Entertainment/Accommodation/Food Services — 52 %
Manufacturing — 37%
Finance/Real Estate/Professional Services — 33%
Health Care/Educational Services — 44%
Wholesale Trade/Retail Trade/Transportation — 37%
Agriculture/Forestry/Fishing/Hunting — 25%
Other Services Except Public Administration — 42%
Mining/Utilities/Construction — 21%
Source: Opting Out of Texas Workers’ Comp Doesn’t Have to Mean Going Bare
Opt-out Programs, cont’d.
Texas Model cont’d.
 Employers in Texas have three choices:
 Join traditional workers’ comp system and abide by laws, rules and
regulations
 Opt-out of statutory system and create their own “non-subscription”
program, which allows more freedom, but they lose “exclusive remedy”
(trade-off so that they are protected from liability lawsuits filed by
employees)
 Opt-out and offer no workers’ compensation benefits or protection and risk
legal liability
 Do not have to adhere to a single strategy for addressing how to privatize workinjury benefits, but more prominent ones share common strategy: adoption of
federal ERISA law for administering work-injury benefits
Source: http://www.wci360.com/files/uploads/WCOpt-OutStudy.pdf
Opt-out Programs, cont’d.
Texas Model cont’d
 Modern opt-out programs also eliminate, truncate or reset 4 elements of
statutory WC system:
 Statutorily defined benefits to injured workers for medical costs and wage
replacement
 State measures to ensure employers will pay benefits, even if employers
file for bankruptcy or insurers become insolvent
 Use of state administrative or civil courts to resolve disputes
 Exclusive remedy
 Six problems controlled or eliminated through non-subscription plans in TX:
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Lack of control over medical provider selection
Weak enforcements of evidence-based medicine practices
Pharmaceutical management and excessive opioid use
Complexities in terminating temporary disability
Pervasive permanent partial disability awards
Cumbersome and expensive dispute resolutions
Source: http://www.wci360.com/files/uploads/WCOpt-OutStudy.pdf
Opt-out Programs, cont’d.
Oklahoma Model
 Ability of employers in Oklahoma to choose alternative to statutory WC
governed by series of requirements and conditions
 Employers must continue to pay benefits at least equal to those mandated
in existing statutory system
 Employers have discretion in designing benefits and managing claims
 Employers who chose to opt-out will retain exclusive remedy against most
negligence lawsuits
 All employers must continue to provide benefits, whether through state
system or under new provisions
 Benefit plans will come in two formats:
 State based
 Federal based — ERISA
Source: https://www.sedgwick.com/news/Documents/Oklahoma%20Option.pdf
Opt-out Programs, cont’d.
 What does opt-0ut programs mean for Medical Tourism in Workers’ Comp?
 Peter Rousmaniere: “opt-0ut right now is rapidly transitioning from a marginal, obscure concept to a
viable, legitimate product in the employee benefits family with a compelling value proposition for
every state.”
 In response to request for clarification and whether this means medical tourism could be implemented
into work comp as an employee benefit, he stated “it makes medical tourism viable for work-injury
benefits, as employer had largely unfettered discretion over selection of medical provider.”
 As more states enact opt-out programs for employers in their states, the likelihood that an employer
would chose to send employees abroad for medical treatment increases
 Given the changing demographics of US labor force and rise of medical tourism destinations in Latin
America and the Caribbean, this possibility is closer to becoming a reality because more states will have
given their employers a choice to stay in the statutory system or allow them to add WC medical care as
another employee benefit which they control and for which they can offer medical tourism as an
option, since they would no longer be subjected to state rules and regulations concerning medical care
for injured workers
Source: Opt-out as a way in: Implementing Medical Tourism into Workers' Compensation
A View From the Bench
 David Langham, Deputy Chief Judge of Compensation Claims, Florida
 “Medical tourism is a reality. How far will it go?”
 Article in December issue of Lex and Verum, mentions medical tourism as a possible
solution to high cost surgeries, Judge Langham’s article referred to domestic medical
tourism from high cost states to low costs states.
 According to Judge Langham, medical tourism has an established foothold in the medical
industry, but states that physicians in the US recommend against it
 They caution that treatments, implants, and medications provided outside US may not be
approved by FDA, and that follow-up care after surgery may be substandard
 Verification of foreign surgeon’s qualifications may also be difficult
 Some states have statutory or regulatory restrictions that confine any attempt to force
insurance carrier to provide medical services outside of state where injured worker lives,
but these restrictions are limited to injured worker, and does not preclude insurance
carrier from voluntarily providing such care and the travel costs associated with it
Source: A View from the Bench: Medical Tourism and its Implementation into Workers' Compensation
Demand for Bundling of WC &
Health Insurance
 More employers seeking to integrate work comp into their benefit packages,
but range of market trends and regulations may be responsible for slowing a
natural fit
 Expanded availability of health insurance could shift payments for injuries and
illnesses covered by work comp to health plans
 Treatments typically covered by health plans may end up covered by work comp
 Many in work comp industry have noted this before and after enactment of ACA
 Major barrier to offering an integrated product is the patchwork quilt of state
laws that prevent the use of narrow provider networks
 Many states regulate whether carriers and employer can offer direct care for
injured workers and have mandated work comp fee schedules
 “Biggest impediment” “is a matter of bringing a product to the marketplace and
making sure it is compliant with state work comp rules”
 Could be alternative in Oklahoma and Texas, and 10 other states
Source: Demand for Bundling of Workers’ Comp and Health Insurance Increases
Financial/Health Care Reform
Outpatient Facility Cost Rising
 Workers’ Compensation Research Institute (WCRI) study, January 2012
 Sample of Major Findings:
 States with no fee schedule regulation on reimbursement had higher hospital
outpatient/ASC costs than states with fee schedules
 The costs in states without fee schedules were 27% to 73% higher than the median of the
study states with fee schedules
 States with fee schedule regulations that were based on a percentage of charges had
higher costs compared to states with other types of fee schedules, such as per-procedure
based or ambulatory payment classification (APC) based fee schedules, with the exception
of Illinois.
 After fee schedule changes, growth in hospital outpatient/ASC costs resumed at faster
rates in states with fee schedule regulations that were based on a percentage of charges.
 Significant variations in hospital outpatient/ASC costs were also found across states
 Compared with the 17 state median, the average hospital outpatient/ASC cost per surgical
episode in Massachusetts—the state with the lowest costs—was 60% lower than the
median study state, while the average cost in Illinois—the state with the highest costs—
was 45% higher, as of 2009.
Source: http://www.wcrinet.org/studies/public/abstracts/hosp_cost_index-ab.html
Rising Hospital Costs
 WCRI study, December 2012
 Work comp carriers noticing bills and payments to hospitals for inpatient and
outpatient services increasing significantly faster than other costs
 Facility costs up in several states, including Indiana, focus of the report
 Indiana’s costs substantially higher than median states in report
 Increase was driven by prices
 Indiana does not have a fee schedule for facilities, which means hospitals can
raise prices whenever they want, and are doing so
 Overall hospital payments per stay increased 12% per year from April 2005 to
September 2010
 At that rate, it was predicted that workers’ comp carrier’s costs will double
every six years
Source: http://www.joepaduda.com/2012/12/hospital-costs-increase/
Employees Unprepared for
Increased Health Care Costs
 2013 AFLAC WorkForces Report
 Employees not financially prepared:
 Only 24% of workers completely agree or strongly agree they will be financially prepared in the
event of an unexpected emergency or serious illness
 Further, 46% of employees have less than $1,000 to be able to pay for out-of-pocket expenses
associated with an unexpected serious illness or accident, and 25% of employees have less than
$500
 Four-in-ten (40%) workers would have to borrow from their 401(k), friends and family to pay for
out-of-pocket expenses associated with an unexpected serious illness or accident; 28% would
have to use a credit card
 Report also stated that:
 Nearly three-quarters (72%) of the workforce have not heard of the phrase “consumer-driven
health care”;
 More than half (54%) of workers would prefer not to have greater control over their insurance
options because they don’t have the time or knowledge to effectively manage it;
 62% of workers believe the medical costs they will be responsible for will increase, while only 23%
are saving money for potential increases;
 75% of workers said they think their employer would educate them about changes to their health
care coverage as a result of reform, but only 13% of employers said educating employees about
health care reform was important to their organization.
Source: http://www.aflac.com/aflac_workforces_report/2013/fast_facts.aspx
Employees Unprepared for
Increased Health Care Costs, cont’d.
 Among consumers of health care plans:
 32% are not very/not at all knowledgeable about health savings accounts
(HSA)
 Three out of four (76%) are not very/not at all knowledgeable about federal
and state health care exchanges
 Almost half (49%) are not very/not at all knowledgeable about health
reimbursement accounts
 25% are not very/not at all knowledgeable about flex spending accounts
(FSA)
Source: http://www.aflac.com/aflac_workforces_report/2013/fast_facts.aspx
Consolidation of US Hospitals Lead
to Higher Cost and Reduces Quality
 Hospital spending is the key driver of healthcare costs in the US and has been growing at nearly 5% year
over year
 One cause of this consistent increase in spending is the continuing consolidation of hospitals around
the country
 This increase in consolidation has given some merged hospital systems oligopoly power to impose fees
that are far higher than those found in areas with high market competition
 Statistics show that hospital consolidation in highly concentrated markets have driven prices up by as
much as 40%
 Because they have increased market power and leverage, hospitals charge private payers higher prices
and are more successful in “cost-shifting” as a result of providing underfunded care
 Studies show that stand-alone and community hospitals typically receive payments from private payers
which are closer to Medicare/Medicaid fees.
 Some of the impacts to cost and quality are as follows:
 Increases the price of hospital care
 Reduces quality of care, through decreased market competition
 Consolidation hasn’t lead to lower costs or improved quality
Source: https://payerfusion.com/ceos-blog/hospital-consolidation-impacts/?goback=%2Egde_2618840_member_221008351
Consolidation of US Hospitals Lead to
Higher Cost and Reduces Quality, cont’d.
Source: Bing Images
Surgical Shenanigans: How Workers’
Comp is being ripped off
 WCRI study in 2013 found there is something different in what hospitals were paid for
shoulder surgeries in work comp and what hospitals were paid by private or group health
insurance for same surgeries
 In half of states studied, hospital outpatient payments for shoulder surgeries in work
comp were at least $2,000 (or 43%) higher than group health insurance
 Worker’s comp payments exceeded group health payments by the most in states where
price regulations were based on percentage of hospital’s charges, or had no price
regulations
 Study compared outpatient payments made by workers’ comp and group health insurers
for treatment of common surgical cases in 16 large states, which represented 60% of the
workers’ comp benefits paid in the US, and covers outpatient services delivered in 2008
Source: http://www.workerscompensation.com/compnewsnetwork/news/16933-wcri-hospitals-were-paid-at-least-2000-more-for-commonsurgeries-for-injured-workers-than-the-typical-patient.html
Physician Shortage and ACA
 Joe Paduda, Managed Care Matters blog post July 2013 – Obamacare and
workers’ comp, part 3
 21% of working-age Americans don’t have health insurance, 31% in Texas to 6 % in
Massachusetts, with several in high 20’s; more than 40 million between 18-64
 Adding 30 million to rolls of insureds to lead to a lot of demand for primary and
specialty care, including check-ups, tests, drugs, evaluation and counseling, as
well as major procedures; knee replacements, shoulder surgery, stents and
cancer treatment
 As it is impractical and not cost-effective to have injured workers travel abroad
for primary care, most likely scenario shortage can be addressed is in specialty
care
Source: http://www.joepaduda.com/2013/07/obamacare-workers-comp-part-3-9/
Physician Shortage and ACA
Source: Bing Images
Physician Shortage and ACA, cont’d.
 WCRI Annual Conference March 2014
 Expansion of Medicaid could impact Workers’ Comp and lead to shortage of
providers to treat workers, which will lead to longer disability and higher costs
 In states where Medicaid expands, shortages will be greater than in nonexpansion states
 States predicted by WCRI to have primary care shortages:
 California
New Mexico
 Florida
Nevada
 Louisiana
Mississippi
 Texas
 Most of these states, with exception of Louisiana and Mississippi, have highest
percentage of Hispanics (Mexicans and others) in the US
Source: Affordable Care Act to Lead to Physician Shortages ― What it Could Mean for Medical Tourism in Work Comp
Physician Shortage and ACA, cont’d.
Note: Four states have expanded Medicaid: AZ, CA, NV & NM.
These are the states with the highest % of Hispanics. TX is the lone
exception.
Source: Affordable Care Act to Lead to Physician Shortages ― What it Could Mean for Medical Tourism in Work Comp
Physician Shortage and ACA, cont’d.
 In states that have already expanded Medicaid, percentage of Hispanics range
from 29.6% to 46.3%
 They will also be some of the states that will experience a shortage of providers
to treat injured workers
 Those states that have not expanded Medicaid will also see a shortage of
providers
 If Medicaid is ever expanded in those states, an alternative must be found to
alleviate the shortages in these states
 That will require a radical re-thinking of who is currently allowed to provide
medical care to injured workers, and can open door to medical tourism
Source: Affordable Care Act to Lead to Physician Shortages ― What it Could Mean for Medical Tourism in Work Comp
Immigration Reform
Immigration Reform and Workers’
Compensation
 Independent Insurance Agents & Brokers of America (IIABA) White Paper
 11 to 12 million undocumented immigrants in the US, depending upon how many “selfdeported” during economic downturn
 5.4 million men, 3.9 million women, and 1.8 million children; additionally there are 3.1
million children who are US citizens due to being born here (64% of all children of the
undocumented)
 Undocumented account for almost one-third of all foreign-born residents of the US, and
about 80% are from Mexico and other Latin American countries
 One of every seven workers in US are foreign-born
 Out of the total number of undocumented adults, 9.3 million, 7.2 million (77%) are
employed and account for around 5% of the workforce
 Foreign workers are skewed toward above average injury risk jobs, and sustain large
share of annual 3 million work injuries
 24% of farm workers, 17% of cleaning workers, 14% of construction workers, and 12% of food
preparers
 These industries account for much of the claims filed under US work comp system
 Undocumented workers comprise a higher percentage of more hazardous occupations:
 36% of insulation workers, and 29% of all roofing employees are undocumented
Immigration Reform and Workers’
Compensation, cont’d.
 Foreign born worker poses higher injury risk due to language barriers, cultural miscues
and poor health literacy
 Immigrant workers will likely sustain 20%, one of every five work injuries
 Most of these workers won’t know much about the US health care system or workers’
comp
 Many won’t have primary care physicians
 Undocumented workers entitled to work comp benefits in 38 states
 6 states have statutes that allow or restrict benefits for various reasons: employment
obtained under false pretenses; entitled to medical, but not disability benefits because of
a commission of a crime under 1986 immigration act
 3 states, California, Georgia and Nebraska have statutes that indicate undocumented
workers are not entitled to benefits in certain circumstances
 11 states were unknown as to whether or not undocumented workers are entitled to
benefits
Source: http://www.independentagent.com/Education/VU/Pages/checklist/VU_IllegalImmigrants.aspx, http://www.joepaduda.com/2013/08/immigrantsworkforce-implications-thereof/, http://www.workcompwire.com/2013/08/peter-rousmaniere-foreign-born-workers-take-centerstage/?utm_source=WCR+Daily+8%2F20%2F13+-+A+New+Leader+Speaks%21&utm_campaign=WCR&utm_medium=email
Immigration Reform and Workers’
Compensation, cont’d.
Source: E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism
Immigrant workers unaware of
Worker’s Compensation
 New Hampshire Dept. of Health and Human Services (DHHS) survey
 Majority of immigrants do not know that if they are injured on the job, they can
get their medical care paid for by work comp
 227 participants out of 366, or 62% were not aware of work comp
 76 participants out of 126 who said yes to understanding work comp wrote down
who told them about it
 29 said they were injured at work, with injuries to their hands, fingers, wrists,
backs, knees, feet, elbows and abdomen
 Majority had been in US for 4-6 year, 17 of 29 had lost time claims
 23 told their supervisors, 4 did not because they left the job due to the injury
 One said they felt that if the injury was reported, they’d be fired
 35% of the respondents were from Latin America and the Caribbean
Source: Survey says most immigrant workers unaware of Workers' Compensation: What this means to Workers' Compensation and Medical Tourism
Conclusion
 Barriers, obstacles and pitfalls exist that prevent medical tourism from
being implemented into workers’ comp
 Yet there are opportunities for the medical tourism industry to offer
medical tourism as an option to employees, employers and insurers
 Workers’ Comp industry must be persuaded that medical tourism offers
better care and lower prices
 Medical Tourism industry must take lead and go after the market; the
market will not come to them
 Medical Tourism industry must lobby at all levels of government to
change outdated laws that restrict medical care to US providers
 Convincing workers, both immigrant and native-born to consider
medical tourism for expensive work-related surgeries won’t be easy, but
must conform to state laws and rules, whether through employers,
carriers or directly
 Medical tourism industry must work with physicians, employers and
insurance carriers to implement medical tourism
QUESTIONS?
Contact Info:
Richard Krasner, MA, MHA
+1 561-738-0458
+1 561-603-1685, cell
Email: [email protected]
Skype: richard.krasner
LinkedIn: https://www.linkedin.com/in/richardkrasner
Blog: richardkrasner.wordpress.com