Differences between Physical Therapy and Occupational Therapy

 

Most Workers Comp Injuries Require Physical Therapy
 
To people who are not in the medical field, there is often confusion between physical therapy and occupational therapy.  People often think injured employees will have “occupational” therapy as the injury arose out of their occupation.  While there are some instances where an injured employee will need occupational therapy, in most workers’ compensation claims, the injured employee needs physical therapy, not occupational therapy.  While physical therapists and occupational therapists deal with many medical issues outside of workers’ compensation, this discussion will be limited to therapy treatment related to workers’ compensation.
 
 
Physical Therapy Restores Musculoskeletal System
 
Physical therapy is a medical service designed to develop, maintain or restore the injured employee’s musculoskeletal system.  When a treating physician refers an injured employee to a physical therapist, the physician will specify the anticipated number of physical therapy sessions needed to restore the employee to the maximum level of recovery. 
 
Upon the receipt of a new physical therapy prescription for the employee, the therapist will schedule the first visit.  At the first visit and in subsequent physical therapy sessions the therapist will:
 
·             Examine the employee’s body part needing therapy
·             Measure and test the employee’s
o   Strength
o   Range of motion
o   Balance, if applicable
o   Coordination
o   Muscle performance
o   Posture, if applicable
·             Develop a treatment plan to accomplish the physician’s goal in the allotted number of sessions
·             Provide exercises to improve muscle strength, range of motion and muscle performance
·             Provide traction and/or deep tissue massage, if needed
·             Provide cold compresses or hot packs, if needed
·             Provide ultrasound treatment or electrical stimulation, if needed
 
 
Goal to Improve Movement Dysfunctions
 
The overall goal of physical therapy is the improvement of an injured employee’s movement dysfunctions and returning the injured employee to the maximum level of musculoskeletal function.
 
 
Occupational Therapy Trains To Improve Functional Abilities
 
Occupational therapy is medical services designed to train and educate an injured person in how to modify their physical environment to improve their functional abilities. Often the occupational therapist will provide instruction on how to use durable medical equipment (prosthetics, crutches and wheelchairs) to increase the employee’s functioning.  The occupational therapist will evaluate the injured employee’s needs and will design a program to overcome the employee’s medical related deficiencies and improve the injured employee’s ability to perform the daily activities of their life.  The occupational therapist will teach the injured employee how to adapt to their physical limitations caused by the work injury.
 
 
Teaches to Adapt to Physical Limitations
 
In addition to teaching an injured employee how to adapt to their new physical limitations, an occupational therapist will often teach the employee on how to prevent and avoid injuries. The occupational therapist will recommend to the injured employee equipment, gadgets and devices that are designed to increase the employee’s safety and increase the employee’s functional ability.
 
 
Best Outcome When Physical and Occupational Therapist Work Together
 
While there can be overlap between the activities of a physical therapist and an occupational therapist, the best outcome for the injured employee is when the occupational therapist and the physical therapist work together.  For example:  An employee is involved in a horrific accident that leaves the employee a paraplegic. The physical therapist will work extensively with the employee to maximize the employee’s remaining functioning of their musculoskeletal system.  The occupational therapist will be brought in to train the employee in how to perform life functions from the confines of a wheelchair.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com
 
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.  

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

The 411 on Functional Capacity Evaluations

 

Tests Performed by Occupational or Physical Therapist
 
A functional capacity evaluation (FCE) is a comprehensive series of test administered by an occupational therapist or a physical therapist who has had specialized training in performing a FCE.  The tests are specifically designed to measure:
 
·         stamina
 
·         dynamic strength
 
·         mobility
 
·         flexibility
 
·         body mechanics
 
·         cardiovascular condition
 
·         balance
 
·         coordination
 
·         dexterity
 
·         ability to tolerate functional activities
 
 
Used to Determine Employee’s Readiness to Return to Work
 
In workers’ compensation claims, a FCE is often utilized to determine the injured employee’s physical readiness to return to work and to measure any physical limitations the employee will have as a result of the work comp injury.  A FCE can also be utilized to determine the injured employee’s physical capabilities for vocational retraining when the injured employee will be permanently unable to return to his/her prior vocation.
 
A FCE can be one of two types, either a job specific FCE or a general purpose FCE. In a job specific FCE, the therapist is provided a detailed job description prior to the testing in order to tailor the FCE to the specific job of the employee.  To have a very accurate FCE, the therapist should visit the jobsite to have a detailed understanding of the functions of the job.  In a general purpose FCE, the testing measures the employee’s strength and tolerance in completing standardized or common work task.
 
 
 
Test Can Last Several Hours to Two Days
 
After a determination of the type of FCE, the appointment date is scheduled for the injured employee.  A FCE can last from several hours to two days, depending on the nature and extent of testing.
 
At the start of the FCE, the therapist will perform a comprehensive interview of the injured employee.  The interview is designed to identify any factors that could impact the employee’s ability to participate in the FCE.  The therapist will want to know if the employee has any issues with asthma, COPD or other lung/breathing problems, high blood pressure, physical limitations besides the work comp injury, and obtain the employee’s own assessment of their physical condition including the employee’s perception of his/her pain level.
 
 
Measure Various Physical Tests
 
In conjunction with the interview, the therapist will complete a clinical assessment of the employee to establish a base line for the FCE.  The therapist will measure the employee’s range of motion, balance, grip strength and coordination to establish the testing plan.
 
In a job specific FCE the therapist will measure the employee’s ability to lift, carry and perform other tasks in comparison to the performance levels identified in the employee’s job description guidelines. In the general purpose FCE the therapist will measure the employee’s maximum ability to lift, carry and perform routine work related task.
 
 
5 Categories of Physical Demands
 
The U.S. Department of Labor characterizes jobs in 5 categories depending on the physical demands of the job.  For instance, an over-the-road, or long-haul truck driver is classified as a “heavy” physical demanding job.  The 5 categories are defined as:
 
·         Sedentary:  exerting up to 10 pounds of force occasionally
 
·         Light:  exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently
 
·         Medium:  exerting 20 to 50 pounds of force occasionally or 10 to 25 pounds of force frequently
 
·         Heavy:  exerting 50 to 100 pounds of force occasionally or 25 to 50 pounds of force frequently
 
·         Very Heavy:  exerting in excess of 100 pounds of force occasionally or in excess of 50 pounds of force frequently or in excess of 20 pounds of force constantly
 
If the therapist is performing a general purpose FCE on a truck driver, the therapist would determine the truck driver’s job is a “heavy” physically demanding job. The general purpose FCE testing would measure the employee’s ability to meet the requirements of the “heavy” job classification.  However, some truck drivers are “drive and drop” drivers where they never touch the cargo.  The hardest part of their job is cranking the landing gear of the trailer up and down and disconnecting the fifth-wheel.  Their job requirements would fall in the “medium” job classification for physically demanding.  Therefore, when there can be different levels of physical effort needed for a job title, it is to both the employer’s and the employee’s benefit to provide a detailed job description to the therapist and to request a job specific FCE.
 
 
Biggest Issue is Validity of Effort by Injured Employee
 
The biggest issue with FCE is the validity of the effort put forth by the injured employee.  If the injured employee has been advised by his/her attorney that the better they do on the FCE, the lower their permanent partial disability settlement will be, the employee is given a financial incentive to put forth less than their best effort.  If there is any concern the employee may not make a sincere effort in the FCE, the therapist should be advised prior to the FCE.  The therapist can give the employee several different tasks or activities that measure the same physical ability.  If the test results reflect a variation in the employee’s ability within a specific category when measured by two or more different methods, the therapist will be able to identify the employee who is trying to game the testing and include in their post testing report the fact that the effort put forth by the employee was inconsistent.
 
 
Results Compared Against Specific Job Description
 
When the FCE testing is completed, the therapist will compile the employee’s test results.  The test results will be compared against the specific job description requirements or the general physical level classification of a job to see if the employee can return to performing the job. The results of the FCE are then reported to the treating doctor and workers’ compensation adjuster and/or nurse case manager. 
 
 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Physical and Occupational Therapy Management Basics Explained

 
 

What is therapy management?

Therapy management is a system aimed at controlling costs of physical medicine such as but not limited to physical and occupational therapy. An entity utilizing clinical and non clinical personnel; contracts with a network of skilled therapy clinicians and actively arranges for and coordinates the most appropriate physical medicine services for patients and employers alike. To learn more about the topic, Roundtable sat down with Greg D'Ambrosio, vice president of client services for the Network Synergy Group to give us an insight to the world of therapy management.
 
 

Why do therapy services need to be managed?

Physical and occupational therapy is no different then other medical costs that have skyrocketed over recent years. Proper management of therapy services can ensure appropriate and medical necessary treatment by expediting scheduling, monitoring patient care and compliance, reimbursing network providers fairly and timely. The result should be a positive outcome and experience for the payor and patient. Better outcomes result in lower costs.

 

Is this a new concept?

Conceptually, managed care arrangements date back to the early 1920s when insurance companies began using prepaid insurance arrangements for specific employee populations. However, the term managed care became popular in the 1980s. The need and development for physical therapy management had its origins in the following decade around mid- to late 1990s.
 

 

How does this help reduce my workers compensation costs?

Physical and occupational therapy is often the last form of treatment prior to a claimant receiving a disability status, reaching maximum medical improvement and returning to work. Therefore, since workers’ compensation is predicated on either restoring the claimants functional capacity prior to the injury and/or returning the claimant back to work, a therapy management program that ensures medically necessary and appropriate care is critical in reducing the overall medical and indemnity costs of a claim.
 


Who should be using therapy management?

Any entity that has a stake and interest in reducing their overall cost of their workers’ compensation claims should be using a therapy management program. This would include self insured employers, insurance carriers, captives and pool arrangements, municipalities, public entities and third party administrators.

 

Why is it advantageous?

Other than the obvious reduction in overall claims costs, the management company should alleviate many of the administrative burdens of an adjuster and or nurse case manager that would have to manage therapy on a case- by-case basis. This allows them to focus on other aspects of a claim.
 

 

Can all companies use this type of service?

There are no restrictions as to what type of companies can use this service. Many companies use this service simply by contracting with their insurance carrier or third party administrator.
 
 

Are there times it might not be beneficial to use such a service?

In workers’ compensation there are always unusual circumstances whereby an adjuster may have a need to manage therapy themselves. However, an overwhelming majority of claims are handled by a therapy management company.
 
 

How does an employer find a good therapy management company?

However, management companies vary significantly in their approach to how therapy is managed. Insurance carriers and TPA’s (third-party administrators) often are affiliated with a therapy management company, but that does not necessarily mean it is the best fit for the client. With the proliferation of the internet and maturation of the industry it would be easy to locate a therapy management company. I would search specific workers compensation sites and blogs such as reduceyourworkerscomp.com to obtain information. Organizations should also identify the best fit for them by speaking with others references in similar industries and positions. Conferences and associations offer great opportunities to speak with peers to obtain information.
 
 

What should a company do if their TPA or insurance company objects to using a therapy management service?

This is simple — ask “Why?” Large employers with high deductibles that assume all or most of their workers’ compensation risk should be able to dictate which service providers are the most appropriate for them. Transparency is critical. A company should ask, “Does the carrier and or TPA somehow benefit in the arrangement by using a therapy management company they have contracted with?” A company should also ensure contractually that they are not limited in selecting service providers when negotiating their workers compensation program or TPA services.
 
 

As a service provider what are the biggest obstacles you encounter with implementation of a new client?

Adjusters are busy and even more so in today’s environment. Scheduling time to fit into adjusters’ schedules to properly implement a program is our biggest challenge. Although not as effective as in person meeting, video conferencing, webinars, and conference calls can help alleviate this.
 
 

As a client, how will I determine the return on my investment?

A client should always focus on outcomes. It is up to each individual client to define what a good outcome is. Patient satisfaction, number of visits per treatment, the duration of care, and the functional capacity status of the patient upon discharge are just a few outcome driven metrics. In addition, there are many overlooked costs associated with therapy management such as bill review and percent of savings charges that need to be contemplated when evaluating the cost benefit of a therapy management program. The customer has to place a value on outcomes that meet or exceed their expectation. Then the analysis becomes simple. If outcomes are meeting or exceeding expectations at what the client can define as a fair price, then the return on investment is a positive one.
 
 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

Greg D’Ambrosio joined Network Synergy Group in 2010 as Vice President of Client Services.  His responsibilities include directing client training and ensuring NSG's therapy management programs are delivered with ease, efficiency and support. Greg has over 20 years of experience in the insurance and PEO industries.  Greg has also been a featured speaker for the NAPEO and Florida Workers' Compensation conferences. He can be reached at: gdambrosio@network-synergy.com or (888) 533-0727 x. 160.

Pat Merrill joined NSG as Vice President of Network Development and Provider Relations in 2011. Pat is currently responsible for the strategic and operational leadership of NSG's Network Development and Provider Relations Departments. She has over 25 years of experience working with large employers; providing solutions for their occupational medicine and workers’ compensation injury care needs.  Pat is a member of the Southern Association of Workers’ Compensation (SAWCA) and the Georgia Self Insured Association. She can be reached at: pmerrill@network-synergy.com or  (813) 207-0727 x. 120 or (404) 314-3225 (c).
 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Occupational Therapy Speeds Recovery of Severely Injured Workers

Occupational therapy is a medical practice that promotes the health of a person to recover from an injury or illness in a way that allows them to return to some degree of self sufficiency after a severe medical condition. Occupational therapy should not be confused with physical therapy which is designed to restore the loss of function to a specific body part. Occupational therapy will assist the severely injured employee to rehabilitate from a disabling injury physically, mentally, and emotionally as they adjust to the permanent loss of function.

 

Occupational therapy
is utilized in various medical situations including: inpatient rehabilitation, acute care hospitals, assisted living facilities, hospices, skilled nursing facilities, and rehabilitation hospitals. For the purpose of this article, we will limit the discussion of occupational therapy to workers compensation and the assistance occupational therapists provide to the severely injured employee. (WCxKit)
 
 

When an employee incurs
a life altering injury like a spinal cord injury, traumatic brain injury, limb amputation, loss of use of a limb or hand, or any injury that prevents the employee from returning to the prior level of employment, occupational therapy is designed to assist the employee to adapt to the permanent loss of function. Occupational therapy is more than just medical recovery. It will also entail psychology, sociology, and other aspects of daily living.
 
 

Occupational therapy will assist
the severely injured employee in numerous ways. The occupational therapist can assist the employee in the following ways.
 

1. Stabilizing the employee's medical condition so the medical condition does not continue to deteriorate

2. Facilitating mobilization

3. Restoring function (overlaps into the area of physical therapy)

4. Compensating for mobility impairment

5. Learning/relearning sensory processes

6. Learning skills to adapt to the loss of function

7. Coordinating care from medical providers of various disciplines

8. Returning the injured employee to a meaningful life

9. Teaching adaptive skills for eating, bathing, grooming, dressing, etc.

10. Teaching the use of adaptive equipment – wheelchairs, artificial limbs, shower benches, etc.

11. Regaining the ability to live independently

 
Occupational therapy can also be utilized when the employee's injury is severe, but not life altering. It is often used in conjunction with physical therapy to optimize the use of a severely damaged hand or arm. The occupational therapist will work with the injured employee to teach the employee to compensate or adjust to biomechanical issues. The occupational therapist will tailor the treatment plan to the individual's needs.
 
 
When the employee has the ability to regain enough physical capacity to return to the former job, or to some time of employment, occupational therapy will provide “work hardening”. Work hardening is a customized approach to recondition the employee's cardiovascular, neuromuscular, and biomechanical systems. Work hardening will use either real or simulated work activities along with exercises to assist the employee in the transition from non-working to working. It will often start with the employee “working” 2 to 4 hours a day, 2 or 3 days a week. The time frame, both sessions and days, is gradually increased until the employee is able to work 8 hours a day, five days a week.
 
 
Occupational therapists are often called upon to provide a functional capacity evaluation (FCE) after the course in work hardening. In an FCE, the employee goes through a series of testing to determine what the employee can safely do in a variety of tasks. The FCE will also be used to establish what level of accommodations, if any, the employer will need to make in order to return the employee to full duty or permanently modified duty. The FCE is also used in some states to establish the level of permanent impairment rating that will be assigned to the employee. (WCxKit)
 
 
Occupational therapy is often the employee's “last stop” in the medical recovery process between injury and the return to work. Or it will be the last stop between injury and the permanent total disability status where the employee will never be able to return to work. The skill level of the occupational therapist can impact the overall outcome. Therefore, it is imperative the employer and the claims office understand the importance of occupational therapy and select the most qualified and skilled occupational therapy facility for the injured employee. 
 
 

Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. Shafer is the author of the leading book on workers compensation cost control  www.WCManual.com   See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Occupational Low Back Pain Part II Workplace Solutions

 

 

 

pic1In part one of this three part series on occupational low back pain (OLBP), we discussed how back pain was the most common reason for worker absenteeism. Also discussed were some statistics related to the scope of OLBP, the most common causes, and an introduction to the importance of workplace involvement in both primary and secondary prevention. In part two of this series, we discuss the concept of workplace intervention in greater detail.

 

 

 

Multiple studies have supported the incorporation of workplace intervention programs for both primary and secondary prevention of OLBP. When discussing primary prevention, the hope is to prevent a low back injury from occurring to begin with.

 

 

 

Secondary prevention is related to those individuals who have already suffered a back injury, but the ideal would be to prevent it from becoming chronic and/or recurring. Ideally, workplaces focus on primary prevention, given the major problem of time lost and disability claims. Due to the unpredictable nature of low back injury, most research is focused on secondary prevention. The buzzword being used in recent research regarding workplace intervention programs is “participatory ergonomics.”(WCxKit)

 

 

 

Research in participatory ergonomics (PE) and return to work indicate a two-fold long-term improvement over clinical interventions (treatment) alone. These programs aim to involve the worker in the process of identifying and correcting factors that negatively impact physical health. This process requires a team approach; members of this team include the employee, the healthcare provider, an ergonomic specialist and a return-to-work coordinator.

 

 

 

The employer must be willing to allow changes to occur in the way work is carried out, as well as the environment in which this work happens. Methods and techniques involved in the PE approach include:

  1. Problem analysis/activity analysis.
  2. Creativity stimulation and idea generation.
  3. Concept development, focus groups.
  4. Concept evaluation, intervention ideas.
  5. Preparation and support- team formation and building.

 

 

 

One of the most effective strategies for preventing low back injury on the job is using selection criteria to match the worker to the job. Any employee who will be performing repetitive tasks or heavy lifting should be screened prior to job placement. An onsite nurse or physician should ideally perform this screening. If a new hire has a previous history of low back injury, significant time should be spent deciding what type of tasks this employee can handle.

 

 

 

Unless a very comprehensive training and ongoing evaluation program is in place, workers with a previous history of LBP would do well to avoid repetitive bending, twisting, lifting, and reaching. Predictors of increased risk of OLBP, which should be very closely assessed in a screening, include:

  1. Previous history of low back pain.
  2. Infrequent physical activity.
  3. Age (older = greater risk).
  4. High work stress.
  5. Lack of social support network.
  6. Depression.

 

 

 

The use of lumbar support braces is often suggested in industries with employees at high risk for OLBP. Employers assume they are providing a safer work environment for employees who have to perform heavy lifting, etc. as part of their duties. There have been many studies examining the use of lumbar support braces; below are some of the conclusions of these studies:

  1. The only group that may benefit from these braces are those with a history of recent back injury, and braces are only suggested as a short term solution.
  2. Back braces should not take the place of training on proper mechanical lifting technique.
  3. Three of every five large, randomized trials failed to show any benefit from the use of back braces.
  4. The Canadian Centr for Occupational Health and Safety and the United States National Institute for Occupational Safety and Health do not support the use of back belts as a preventive measure.(WCxKit)

 

 

 

Implementing workplace solutions for OLBP prevention can be a time-consuming process, and therefore may not take precedence in the realm of things managers have to deal with on a daily basis. However, based on the information provided in the first two articles of this series, we hope the problem of OLBP will be given more thought. After all, business will ultimately suffer when workers are not able to perform their jobs because they are on disability! For the last part of this series, we will discuss various treatment options for those with low back pain. Stay tuned!

 

 

Authors: Brian Anderson DC, MPH, CCN and David Radford DC, MSc

 

 

Dr. Anderson works as a supervising clinician and instructor at National University of Health Sciences in Lombard IL. He has been in private practice, as well as part of a team in a University based Integrative Medicine setting. In addition, Dr. Anderson has experience in the medico-legal field, serving as an expert for various insurance companies and legal firms. He earned a Masters Degree in Public Health, as well as a Certified Clinical Nutritionist designation. He is currently working toward a specialty diplomate in Functional Rehabilitation. Contact Dr. Anderson for more information at banderson@nuhs.edu

 

 

Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at DCR8888@aol.com or (440)-248-8888.

 

Resources:

-Use of back belts to prevent occupational low-back pain. CMAJ, AUG. 5, 2003; 169 (3)

-Finding ergonomic solutions—participatory Approaches. Occupational Medicine 2005;55:200–207

-Designing a workplace return to work program for occupational low back pain: an intervention mapping approach. BMC Musculoskeletal Disorders 2009 10:65

 


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Texas Requiring Preauthorization: Reduces Costs, Return to Work Not Affected

By requiring preauthorization for occupational therapy services, spinal surgery, and work hardening and conditioning services, a study showed three Texas reforms from the early 2000s lowered medical costs without hurting injured workers’ return to work.
 
 
The Workers Compensation Research Institute (WCRI) study, Impact of Preauthorization on Medical Care in Texas, found when an insurer requires preauthorization there was a seven percent reduction in the number of injured workers receiving physical medicine and occupational therapy. Further, there was a 39 percent reduction in the number of visits per worker. Preauthorization also reduced the number of patients receiving more than 15 visits for physical medicine services.
 
 
According to the study’s abstract, “Texas policymakers enacted several reforms that were intended to give payors additional tools to manage medical care, patient outcomes, and costs. One class of reforms requires preauthorization by the payor for certain types of medical treatments and services.”
 
 
Among the workers compensation rules in Texas, an injured employee is required to receive approval from the insurance carrier before receiving occupational therapy services, spinal surgery, and work hardening and conditioning services.
 
 
To complete the study, WCRI used medical billing data for two sets of claims — one prior to the effective date of the preauthorization reform and one after. The abstract says, “For each type of medical care, WCRI measured changes in utilization after the preauthorization reforms. … WCRI also studied changes in disability duration and return-to-work as measured by the days in which an injured worker received temporary disability payments.”
 
 
The abstract says the study addresses these three questions:
1.      What impact does preauthorization have on reducing medical visits?
2.      Does preauthorization hamper return to work?
3.      Did preauthorization create a delay in spinal surgeries for injured workers?
 
 
3 Study Findings:
1.      Return to work did not change significantly over the time period for injured workers who received physical medicine services.
2.      There was a 21 percent reduction in the number of injured workers receiving work hardening and work conditioning services, but not significant changes in the number of visits and services per visit.
3.      Time to surgery was shorter among injured workers who received spinal surgery after preauthorization was effective.
 
 
You can read more about the study here.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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