benefits they strive to work with local physicians, hospitals and other medical providers to establish relationships to ensure the provision of quality benefits for their employees.

If you have an interest in providing healthcare services to nonsubscribers, here are a few things to consider.

What is Nonsubscription?
Although many businesses elect to operate as nonsubscribers a significant percentage provide occupational injury benefits through an employer-funded injury benefit program. Texas employers choose nonsubscription for the same reasons many healthcare providers elect not to treat workers’ compensation patients—the cost, complexity and inability to manage outcomes.

One of the primary differences between subscribing and nonsubscribing employers is liability. The exclusive remedy doctrine associated with workers’ compensation provides an agreed level of benefits to an injured employee in exchange for a limit on liability that precludes most negligence claims. Nonsubscribing employers, on the other hand, are not protected from tort claims. They do however have some legal protection as well as the opportunity insure liability exposure.

Because they are not protected by exclusive remedy, nonsubscribing employers must take additional steps to mitigate the liability. Safety and injury prevention is a mainstay of all nonsubscriber programs but another important element is employee satisfaction. Nonsubscribers are motivated to establish relationships with quality healthcare providers to ensure their employees receive quality care and good outcomes.

Establishing Relationships
While nonsubscribers provide workplace injury benefits similar to their subscribing counterparts, the programs are quite different. Workers’ compensation is a highly regulated system with claims managed by a third party. Nonsubscriber programs allow for a more direct role in claim management with some employers actually managing their claims in-house.

Nonsubscribing employers and healthcare providers can establish relationships regarding the treatment of injured employees. These agreements might include how and when payments will be made, filing forms, if any, rates and more.

Provider agreements should promote economic incentives rather than price controls and regulation as the method for reducing costs and improving care. Nonsubscribers typically pay quicker, allow higher rates and require much less paperwork but in return, they will expect quality care and good outcomes.

Determining Market Potential
It is important to determine the nonsubscriber market potential for your geographic area because the number of nonsubscribing businesses varies by geographic area and industry type. Here are some statistics from a study by Texas A&M University regarding nonsubscribing businesses.

As you can see, if there is a large concentration of restaurants, hotels and grocers in your area there is probably also a large number of nonsubscribing businesses. On the other hand, if you operate in an area that hosts a lot of government and professional offices, these businesses do not tend to be nonsubscribers.

Another factor is the size of the business. Larger businesses are more likely to establish a formal relationship with providers than smaller businesses. Larger businesses also tend to insure the benefits offered by their nonsubscriber program (i.e. wage, medical and other benefits) with a large deductible policy, which means that in many cases they may pay for medical services directly. Not only does this method expedite payments it also eliminates dealings with a third party and greatly reduces paperwork.

Third Party Agreements
Healthcare providers may also choose to consider establishing relationships with third party providers that facilitate claims on behalf of nonsubscribers. Insurance carriers and third party administrators frequently work with medical providers. In addition, a number of nonsubscriber networks have been established to help nonsubscribers gain access to quality healthcare providers.

What’s the Catch?
In most instances nonsubscriber agreements are established up front thereby reducing the occurrence of problems. But if there is a downside, some providers may express frustration with their ability to gain business from Texas nonsubscribers.

Gaining business from nonsubscribers is not automatic and therefore requires providers to market their services. In some communities simply asking for the businesses may suffice while in other situations more aggressive programs and mailings that target key officials may be required.

Assessing Your Situation
If you are interested in working with nonsubscribers, look that the circumstances in your community and your practice. It may also be important to:

• Understand the difference between nonsubscription and workers’ compensation
• Understand provider and employer relationships
• Determine the market potential of your area
• Understand what is required to secure nonsubscriber business
• Determine if your practice is committed to gaining and maintaining nonsubscriber business
• Determine if nonsubscriber business fit the unique needs of your practice