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 surveillance. Experience suggests that Massachusetts CHCs serving low income workers face significant obstacles to using WC. We used qualitative and quantitative approaches to describe barriers Massachusetts CHCs face in using WC.

Methods We conducted in-depth interviews with administrators and providers from a sample of CHCs and a mail survey of medical directors and chief financial administrators of all CHCs throughout Massachusetts.

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. Knowledge barriers included lack knowledge about the WC system and how to use it 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 need for: 1) further research documenting denials, delays; 2) educational initiatives for CHC staff about the WC system and how to use it; 3) innovative strategies to provide occupational health support 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 these recommendations.