Few injuries these days avoid a trip for physical therapy. Considering that the main injury is typically a sprain/strain, it is almost commonplace that after the first trip to the doctor you get an Rx for some medication along with an Rx for a course of physical therapy.
This could be a good thing or a bad thing, depending on your past experiences. Plenty of claims people are quick to dismiss physical therapy after initial visits, judging that it is only a way for the clinic owner to obtain more money from said carrier/TPA. After all, a home exercise program is the most important thing, right?
The answer to that question is maybe. Of course, a home exercise program is important, but only if the injured worker (1) actually does it at home and (2) does it as often as they are supposed to. Sadly, most people fail to comply with the outlined home exercise program, and instead focus on “Taking it easy while they are off of work because that is how injuries heal.”
Physical Therapist – Doctor Communication Key To Success
I am no doctor, and in fact, far from it. As much as I wish I did have MD after my name, I do not. I can speculate, and I can talk as fancy as a doctor can sometimes, but I am no doctor. But I do know that in order to get better you have to put some work in by rehabbing most injuries. So when your injured worker is sent for therapy, do you know the program or the therapist in charge of their care? Are the doctor and the therapist talking in order to gauge the progress of the patient and modify the therapy script as needed? Does the therapist take good notes or just jot down reps from stretches then bill $250 per visit?
Those are important questions. In states where you can direct care, you see a lot of employers linking up with one therapy clinic provider, that way you know where the injured party is going, and it simplifies billing and streamlines the overall referral process. If you want to go down this route, you have to choose the best therapist providers and believe in their programs. This can only be done by using real-life cases as your proof that this particular therapy program works. In addition, you need to consider that the therapist overseeing the program cares about your workers, discharging patients from care, and not keeping them in a therapy program for weeks on end when it may not be doing any real tangible good.
So let’s say you have the option to direct care, and you want to pick a therapy provider to send all of your cases to. What makes a good therapy provider? Consider the following:
Does the therapist talk to the doctor to address/update work restrictions?
One of the most important things about physical therapy is the intertwining of the program with the recommendations from the treating physician on the file. Too often the doctor sends the injured worker to therapy, and then never receives any progress notes, never talks to the therapist, and instead just goes on the verbal subjective update direct from the patient. Doing this is not accurate. Even if the patient states that they are seeing some improvement, what does that mean? Is their range of motion better? If so, by how much? Can they be discharged to a home exercise program, or can therapy frequency be decreased? If that is the case, who makes sure they are making continual progress and not having any setbacks?
Communication is always key, so you want a therapist that stays involved in all aspects of the medical care of the case, and is not afraid to follow up with the doctor to give a verbal or written update before their next physician evaluation.
Ask the therapist if they are noticing subjective pain complaints, positive Waddell’s signs, or an overall lack of participation in the prescribed home exercise program
Chances are that the therapist will see the patient a lot more than the treating doctor. Physician appointments can be a few times per month if even that close together. The therapist on the other hand may see the patient 3-4 times per week, for multiple weeks depending on the injury or surgery recovery. The therapist can better gauge pain behavior with completion of the therapy tasks, and they should be taking notes on inconsistent behavior, excessive pain complaints, or refusal to comply with certain exercises or the home exercise program. Then these issues need to be brought to the physician’s attention and addressed accordingly.
Show the therapist your light duty/full duty work jobs so they can gear rehab towards a certain range of motion movements, repetitive lifting movements, etc.
The best way to rehab an injured worker is to know what their actual job entails. That way a therapy program can be tailored to suit the needs of the injured worker. If you have the choice to steer patients to one therapy clinic, have the therapists come to your shop to check out the jobs, and provide the therapists with detailed job descriptions for all occupations that they can keep on file. This way they can tailor a program for the injury and for the occupation of the patient, which should yield better, quicker results. This way there should be less chance of re-injury once the worker does indeed go back to the workplace either light duty with restrictions or full duty.
Be sure your therapist utilizes detailed note-taking and does an overall progress update after every 2-3 weeks of completed therapy
If the doctor has no idea what the patient is doing in therapy, how would they know if the patient needs more therapy to begin with? We have all seen terrible therapy notes at once time or another. These consist of little scribbles, daily sign-in sheets used as progress notes, and lack of a total cumulative report based on the progress made to date since the onset of the physical therapy program. All of these instances should be deemed unacceptable since you the adjuster also have no idea of what is going on at physical therapy. Detailed subjective complaints along with objective findings are just as important in physical therapy notes as they are in medical notes from the physician.
When you are scouting places to send your injured workers, ask for examples of progress notes or examples of their progress updates so you can see for yourself what the treating doctor will see when reviewing the file and determining the need for continuation of the therapy program. This way you know what to expect.
If qualified, have your therapist perform an FCE for those cases with permanent restrictions
From time to time there are injuries and surgeries that will necessitate permanent restrictions. When this is the scenario, it is extremely important that the doctor and the therapist work together in determining what those permanent restrictions will be. A good percentage of the clinics out there have a therapist that is qualified to perform a Functional Capacity Exam (FCE). This is where the worker is put through a series of tests to see what their maximum occupational activity level should be once they have achieved MMI. Just leaving a doctor to address this alone is incomplete. The doctor may have an idea, but without objective testing how can you determine the accuracy? Plus some injuries can take years to really rehab from. It is actually a lifestyle change in addition with activity modification that will allow the patient the best functionality possible. Just one FCE result may not mean that those restrictions are totally set in stone for as long as the patient is alive.
The patient may need yearly FCE evaluations, and if the patient is doing what they are supposed to you may be able to see small improvements in function over a course of years. If you fail to retest the injured party, how do you know if they are getting better, or worse? Consistency and communication are key elements in the proactive care of a long-term injury claim, no matter what type of injury was sustained.
Being able to direct care is a valuable asset to certain employers/carriers/TPAs when it is available in certain jurisdictions. But this is only an asset when it is used properly. You should be screening all designated occupational clinics and all therapy clinic providers. Failure to do the homework on your end is not going to help you, and you lose out on the luxury of being able to provide good quality objective care that can shave precious dollars off of the cost of your claims.
Author 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: firstname.lastname@example.org.
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