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 [email protected]

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

Risk Management

The Profession

After 20 years in the business, Navy Pier’s Director of Risk Management values her relationships in the industry more than ever.
By: | June 1, 2017 • 4 min read

R&I: What was your first job?

Working at Dominick’s Finer Foods bagging groceries. Shortly after I was hired, I was promoted to [cashier] and then to a management position. It taught me great responsibility and it helped me develop the leadership skills I still carry today.

R&I: How did you come to work in risk management?

While working for Hyatt Regency McCormick Place Hotel, one of my responsibilities was to oversee the administration of claims. This led to a business relationship with the director of risk management of the organization who actually owned the property. Ultimately, a position became available in her department and the rest is history.

R&I: What is the risk management community doing right?

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The risk management community is doing a phenomenal job in professional development and creating great opportunities for risk managers to network. The development of relationships in this industry is vitally important and by providing opportunities for risk managers to come together and speak about their experiences and challenges is what enables many of us to be able to do our jobs even more effectively.

R&I: What could the risk management community be doing a better job of?

Attracting, educating and retaining young talent. There is this preconceived notion that the insurance industry and risk management are boring and there could be nothing further from the truth.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

In my 20 years in the industry, the biggest change in risk management and the insurance industry are the various types of risk we look to insure against. Many risks that exist today were not even on our radar 20 years ago.

Gina Kirchner, director of risk management, Navy Pier Inc.

R&I: What insurance carrier do you have the highest opinion of?

FM Global. They have been our property carrier for a great number of years and in my opinion are the best in the business.

R&I: Are you optimistic about the US economy or pessimistic and why?

I am optimistic that policies will be put in place with the new administration that will be good for the economy and business.

R&I: What emerging commercial risk most concerns you?

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The commercial risks that are of most concern to me are cyber risks, business interruption, and any form of a health epidemic on a global scale. We are dealing with new exposures and new risks that we are truly not ready for.

R&I: Who is your mentor and why?

My mother has played a significant role in shaping my ideals and values. She truly instilled a very strong work ethic in me. However, there are many men and women in business who have mentored me and have had a significant impact on me and my career as well.

R&I: What have you accomplished that you are proudest of?

I am most proud of making the decision a couple of years ago to return to school and obtain my [MBA]. It took a lot of prayer, dedication and determination to accomplish this while still working a full time job, being involved in my church, studying abroad and maintaining a household.

R&I: What is your favorite book or movie?

“Heaven Is For Real” by Todd Burpo and Lynn Vincent. I loved the book and the movie.

R&I: What’s the best restaurant you’ve ever eaten at?

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A French restaurant in Paris, France named Les Noces de Jeannette Restaurant à Paris. It was the most amazing food and brings back such great memories.

R&I: What is the most unusual/interesting place you have ever visited?

Israel. My husband and I just returned a few days ago and spent time in Jerusalem, Nazareth, Jericho and Jordan. It was an absolutely amazing experience. We did everything from riding camels to taking boat rides on the Sea of Galilee to attending concerts sitting on the Temple steps. The trip was absolutely life changing.

R&I: What is the riskiest activity you ever engaged in?

Many, many years ago … I went parasailing in the Caribbean. I had a great experience and didn’t think about the risk at the time because I was young, single and free. Looking back, I don’t know that I would make the same decision today.

R&I: What about this work do you find the most fulfilling or rewarding?

I would have to say the relationships and partnerships I have developed with insurance carriers, brokers and other professionals in the industry. To have wonderful working relationships with such a vast array of talented individuals who are so knowledgeable and to have some of those relationships develop into true friendships is very rewarding.

R&I: What do your friends and family think you do?

My friends and family have a general idea that my position involves claims and insurance. However, I don’t think they fully understand the magnitude of my responsibilities and the direct impact it has on my organization, which experiences more than 9 million visitors a year.




Katie Siegel is an associate editor at Risk & Insurance®. She can be reached at [email protected]