Physical Therapy Costs 105% More in Workers’ Comp; But It Could Well Be Worth It

A new report found that workers’ compensation patients are more likely to receive physical therapy treatments and attend more appointments than those in group health. 
By: | January 2, 2020

Physical therapy can be a great tool for getting injured workers back on the job. 

The treatment has been used in lieu of surgery in some cases and it can help workers’ compensation patients with chronic pain avoid opioids. 

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But while physical therapy can be a great tool for injured workers, payers might be concerned about the costs, which can be much higher than in group health for the same physical therapy treatments. 

MedRisk’s 2019 Industry Trend Report on Physical Medicine in Workers’ Compensation compiles data on the costs of physical therapy in workers’ comp when compared to group health, provides updates on how state regulations are affecting physical therapy utilization and where the industry is heading. 

The Report By the Numbers

The report looked at recent research from NCCI and data from MedRisk to compare the utilization and costs of physical therapy in workers’ comp to group health. 

They found that the quantity of care rather than unit cost was driving much of the cost difference. 

  • Overall, physical therapy in workers’ compensation costs almost three times as much as it does in group health. 
  • Part of this is utilization, but there is also a price differential. The utilization of physical medicine in workers’ comp is 268% that of group health and there is a price unit differential of 105%.
  • Workers’ compensation patients are 45% more likely to receive physical therapy than group health patients. 
  • They also have 50% more visits per patient than group health.    

States Make Physical Therapy Easier to Access

Part of the reason physical therapy is becoming more widely used in workers’ comp is because states are making it easier to access for injured workers through PT-first initiatives, legislation and PT compacts. 

In Ohio, the state’s bureau of workers’ compensation now requires people with work-related back injuries to participate in 60 days of non-surgical care, including physical therapy, before receiving spinal fusion surgery or an opioid prescription.

While Ohio’s PT-first initiative largely aims to curb opioid use among injured workers, New York’s Assembly Bill 02005/Senate Bill 01505 makes physical therapy more accessible to patients. 

The law allows workers’ compensation patients to receive treatment by an authorized physical therapist, acupuncturist or occupational therapist upon the prescription or referral of an authorized physician, physician’s assistant or nurse practitioner. 

Other states, including Arizona, Arkansas, Colorado, Kentucky, Nebraska, North Carolina and Virginia, have enacted legislation to join the PT Compact, which allows physical therapists licensed in one state to practice in another state in the compact. 

This enables multi-jurisdictional practices and expands the access patients have to physical therapy.

Getting Costs Under Control

Physical therapy can be an important piece in an injured worker’s journey back to health, but care that is not delivered efficiently can lengthen claims and drive up costs for payers.

“Physical therapy is prevalent and valuable in workers’ compensation, helping patients recover functionality, avoid opioids, and safely return-to-work,” Mary O’Donoghue, chief clinical and product officer at MedRisk, said in a press release. 

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 “Yet there’s a great need to carefully manage the quality and cost of care … It’s not about arbitrarily limiting visits; it’s about clinical management, communication and technology that streamlines workflows.”

MedRisk has introduced quality management practices, including PT-to-PT coaching, to help reduce the number of visits-per-patient and the duration of care. Looking at data from 2015 to 2019, the company found they were able to reduce the number of visits by 11.19% and the duration of care by 24.97%. 

Technology and changes to the workers’ compensation process can also reduce costs for payers by helping workers receive care faster. 

One Call has sponsored research at George Washington University to see how systems engineering can be used to reduce the amount of time patients wait for physical therapy appointments.   

In addition to making sure patients receive their care efficiently, payers can reduce costs using telerehab, which can reduce the amount of time it takes an injured worker to return-to-work by ensuring patients don’t miss appointments. &

Courtney DuChene is a staff writer at Risk & Insurance. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]