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 claimant’s 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: firstname.lastname@example.org 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: email@example.com or (813) 207-0727 x. 120 or (404) 314-3225 (c).
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