How To Manage Physical Therapy Costs in Workers’ Comp and Still Deliver Excellent Care
Much has been made of the benefits of early physical therapy intervention for a variety of common injuries in workers’ compensation, however, in practice the decision is much more nuanced.
“We have data that show that low back, shoulder and knee injuries respond particularly well to early PT. We looked at starting PT within three days of an injury and we did benchmarks in between up to 30 days post-injury date and we found substantial benefits with shoulders, backs and knees,” said Michelle Despres, VP of Physical Therapy at One Call.
“It’s faster recovery, fewer PT visits, less duration, and it’s lower cost. And the reason that a lot of this makes sense is because PTs are experts at movement science, so if you have something that hurts and you’re being protective or your muscles are being protective of that joint, getting PT very early can prevent any of those compensatory type motions.”
This relationship seems to be receiving enhanced notice across the industry. A 2020 study, “The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation?”, from the Workers’ Compensation Research Institute (WCRI) found a strong association between physical therapy timing and outcomes for the low back pain-only subset of injuries across its study states.
Implementing PT at the Right Time
On average, according to WCRI, weeks of temporary disability per claim was 58% longer for those with PT initiated more than 30 days post-injury. The percentage of attorney involvement in cases where PT began at 30 days post-injury or later was also significantly higher.
However, part of the PT puzzle for employers and claims personnel is the question of appropriateness of PT, as the risk of aggravating an injury can present itself.
“It becomes very important to make a correct diagnosis from the very beginning. Structural injuries such as ligament and tendon tears and fractures should be identified early. Physical therapy in this setting could worsen the situation,” said Dr. James Kercher, of Peachtree Orthopedic Clinic. Kercher will be speaking on the topic of physical therapy spending at the National Workers’ Compensation and Disability Conference.
“Certain injuries which occur inside the joint may actually lead to more damage if treated with early physical therapy and joint mobilization. The distinction is not always clear in the acute setting and providers must always have a high level of suspicion.”
Within that suspicion, on the side of the claims examiner, is also the degree to which PT should continue without significant improvement. While guidelines can be helpful, experienced claims organizations will use a combination of factors to assess status.
“PT is very much an intricate part of the rehabilitation process for any injury, work or non-work related, however, there is a point where PT is effective or ineffective and often ineffective after a certain period of treatment can become the harder issues to manage through expectations,” said Susan Emerson, owner of Emerson Claims Advisory.
“PT can be appropriately used to help control and manage the pain to avert and avoid the pain pill crisis that the US has seen through the years. But this has to be balanced so as not to create an issue of over prescribing and over use of PT.”
The American Physical Therapy Association’s (APTA) ChoosePT campaign is focused on raising awareness about the palliative benefits of PT for many common injuries, citing guidance from the CDC which encourages patients to opt for PT when the risks of opioid use outweigh the rewards, patients want to do more than mask the pain, and when pain has become chronic, usually past the 90 day mark.
“PTs are also experts in manual therapy so we can provide immediate techniques that provide relief,” Despres noted.
In addition to timing, the number of PT visits is an oft-discussed issue, especially when utilization review requirements differ from what a doctor has discussed with an injured worker, making the communication of guideline limits important.
“This causes a lot of problems with the injured worker when PT is ordered outside the guidelines in UR states,” Emerson said.
“The injured employee hears, ‘My doctor said I needed 20 visits, but you are only approving 10.’ They don’t hear ‘let’s reassess at 10 and see what else is needed.’ Or the physician and PT providers are not communicating well on the progress of the patient to better understand what is necessary or not necessary. This can also create unnecessary litigation or lead an employee to seek an attorney when medical services are being prescribed outside the guidelines.”
Streamlining Communication in the Healing Process
As with many aspects of workers’ comp claims management, the necessity of maintaining a throughline from provider to injured worker to claims representative is essential to reducing friction and frustration in the process of healing.
Even among professionals in the medical space accustomed to treating within the workers’ comp system, effective transmittal of information about a patient’s progress and ongoing needs can break down.
“The most important recommendation is to have the best possible team managing workplace injuries. Overlooking or misdiagnosing an injury from the outset can lead to high cost and damaged outcomes,” said Dr. Kercher.
“With regard to monitoring intended outcomes, communication is key. With electronic medical records many times physical therapy progress notes are computer-generated with very little information for the provider. Furthermore there is a high degree of separation between contract therapists and providers, which adds more difficulty. Physicians need to work hand-in-hand with therapists in order to ensure everything is kept on track.”
As long term frequency in workers’ comp trends downward due to improved safety and other factors, physical therapy has become a firstline major treatment modality in many states.
In a separate WCRI study, the 2017 18-state median for claims with a physical medicine services component was up to 63%. These trends are going nowhere but up, and are bringing spending considerations along with them. With the right tools to assess reasonable necessity, claims handlers can expect faster and safer recovery. &
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