Barriers to Use of Workers' Compensation for Patient Care at Massachusetts Community Health Centers

BACKGROUND:

Appropriate use of workers’ compensation (WC) insurance has important ramifications for patient access to care and other benefits, health care resources more generally, and public health that uses WC data for injury and illness surveillance. WC can be particularly useful for community health centers (CHCs) that provide primary and preventive care to low income workers disproportionately employed in high risk jobs. Yet experience suggests that Massachusetts CHCs face significant obstacles to using 

METHODS:

We conducted in-depth interviews with administrators and providers from a sample of  CHCs throughout Massachusetts. Questions addressed CHC reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of medical directors and chief financial administrators at all 76 CHCs. Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated.

RESULTS:

 Ten professionals from 8 CHCs completed interviews. Survey questionnaires were returned from 56 CHC sites (74%).  Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: “We see an awful lot of work-related injury, and I would say that most of it doesn’t go through workers’ comp.”  Knowledge barriers included lack knowledge about the WC system, confusion about how to use the WC system, and uncertainty about work-relatedness. Systems barriers within CHCs included reliance on patients to identify work-relatedness of their conditions at registration, and difficulty tracking down WC insurance information.  Patient hesitancy to use WC and excessive paper work were also barriers. Reimbursement delays and denials lead patients and CHCs to absorb costs of services.

CONCLUSIONS:

Findings underscore the need for: 1) further research documenting denials, delays and other barriers within the WC system itself and steps to address these barriers; 2) educational initiatives about the WC system and how to use it targeting administrators and other CHC support staff as well as providers and workers; 3) innovative strategies to provide occupational health support, e.g. clinical decision support tools, and consultation, to CHC primary care providers; and 4) systems changes within CHCs and other resources for CHCs to address barriers in work flow.  Efforts are underway in Massachusetts to implement recommendations.