Risk Insider: Phil McClure

Therapy: Not Surgery

By: | May 16, 2017 • 2 min read
Dr. Philip McClure is an internationally recognized educator and expert in physical medicine and vice president of MedRisk’s ECB. He is a professor and chair of the Doctor of Physical Therapy Program at Arcadia University in Pennsylvania. He can be reached at PMcClure@medrisknet.com.

The medical community is changing its approach to low back pain, forgoing MRIs and aggressive surgeries in favor of first trying physical therapy.  A 2015 Fritz et al study showed that patients first sent for MRIs were more likely to receive surgery or injections, require specialty care or visit an emergency room. Their low back pain-related charges averaged $6,193, which was $4,793 higher than patients who received physical therapy before imaging.

The traditional biomedical model suggests that pain reflects a structural problem and fixing the problem will eliminate or reduce the pain. When physicians saw a herniated disk on an MRI. for example, they assumed it was causing the pain.

However, surgery does not always alleviate pain. Many people have herniated disks with no symptoms.

There may always be some residual weakness, but unless the patient is a major-league pitcher or lifting roof shingles overhead every day, 80 percent capacity is usually enough.

Newer findings indicate that low back pain cannot easily be explained by simple pathological anatomy and imaging. Many causes of pain, such as inflammatory cascades, changes in neurotransmitters or psychosocial issues, cannot be imaged.

Similarly, rotator cuff surgery does not always reduce pain, and many people who have tears have no pain at all. Over 50 percent of patients improve significantly without surgery, and this rate is higher when examining only non-traumatic injuries.

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While traumatic or acute tears may require surgery, one study by Kuhn showed that six weeks after first participating in an exercise-based physical therapy program, only 25 percent of patients with non-traumatic rotator cuff injuries opted for surgery.

Conservative care can involve multiple treatment paths that work together, including exercise. Most researchers and physicians now believe that appropriate physical training can strengthen the muscles around the shoulder to compensate for deficiencies in the injured or degenerative rotator cuff and preserve functionality.

There may always be some residual weakness, but unless the patient is a major-league pitcher or lifting roof shingles overhead every day, 80 percent capacity is usually enough.

Conservative care of shoulder pain can lead to savings for payers by eliminating the cost of the surgery and related medication and rehabilitation. However, surgeons struggle with deciding which patients need surgery and which will respond to non-operative therapy because there is no consensus in the medical community or clear diagnostic guidelines.

While a conservative surgeon might recommend physical therapy as initial treatment, a more aggressive surgeon may feel the issue needs to be fixed before it gets worse.

These challenges mirror those seen several years ago with low back pain. Today conservative care is clearly indicated for low back pain and used as the initial treatment path for many patients.

Patient expectations, job satisfaction, social support at home and work, how patients think about disability, and how much diagnostic imaging they’ve received also impact pain and recovery.  All of these factors seem to hold true, whether the injury is in the back or shoulder.

More from Risk & Insurance

More from Risk & Insurance

2017 Risk All Stars

Immeasurable Value

The 2017 Risk All Stars strengthened their organizations by taking ownership of improved risk management processes and not quitting until they were in place.
By: | September 12, 2017 • 3 min read

Being the only person to hold a particular opinion or point of view within an organization cannot be easy. Do the following sound like familiar stories? Can you picture yourself or one of your risk management colleagues as the hero or heroine? Or better yet, as a Risk & Insurance® Risk All Star?

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One risk manager took a job with a company that was being spun off, and the risk management program, which was built for a much larger company, was not a good fit for the spun-off company.
Rather than sink into inertia, this risk manager took the bull by the horns and began an aggressive company intranet campaign to instill better safety and other risk management practices throughout the organization.

The risk manager, 2017 Risk All Star Michelle Bennett of Cable One, also changed some long-standing brokerage relationships that weren’t a good fit for the risk management and insurance program. In her first year on the job she produced premium savings and in her second year is in the process of introducing ERM company-wide.

Or perhaps this one rings a bell. The news is trickling out that a company is poised to dramatically expand, increasing the workforce three- or four-fold. Having this knowledge with certainty would be a great benefit to a risk manager, who could begin girding safety, workers’ comp and related programs accordingly. But things sometimes don’t work that way, do they? Sometimes the risk manager is one of the last people to know.

The Risk All Star Award recognizes at its core, creativity, perseverance and passion. The 13 winners of this year’s award all displayed those traits in abundance.

In the case of 2017 Risk All Star winner Steve Richards of the Coca-Cola Bottling Company, the news of an expansion spurred him to action. He completely overhauled the company’s workers’ compensation program and streamlined its claim management system. The results, even with a much higher headcount, were reduced legal costs, better return-to-work experiences for injured workers and a host of other improvements and savings.

The Risk All Star Award recognizes at its core, creativity, perseverance and passion. The 13 winners of this year’s award all displayed those traits in abundance. Sometimes it took years for a particular risk solution, as promoted by a risk manager, to find acceptance.

In other cases a risk manager got so excited about a solution, they never even considered getting turned down. They just kept pushing until they carried the day.

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Butler University’s Zach Finn became obsessive about what he felt was a lackluster effort on the part of the insurance industry to bring in new talent. The former risk manager for the J.M. Smucker Co. settled on the creation of a student-run captive to give his risk management students the experience they would need to get hired right out of college.

The result was a better risk management program for the university’s College of Liberal Arts and Sciences, and immediate traction in the job market for Finn’s students.

A few of our Risk All Stars told us that the results they are achieving were decades in the making. Only by year-in, year-out dedication to gaining transparency about her co-op’s risks and learning more and more about her various insurance carriers, did Growmark Inc.’s Faith Cring create a stalwart risk management and insurance program that is the envy of the agricultural sector. Now she’s been with some of her insurance carriers more than 20 years — some more than 30 years.

Having the right idea and not having a home for it can be a lonely, frustrating experience. Having the creativity, the passion and perhaps, most importantly, the perseverance to see it through and get great results makes you a Risk All Star. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, perseverance and passion.

See the complete list of 2017 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at dreynolds@lrp.com.