When an employee suffers an injury to musculoskeletal system, the medical provider will frequently recommend a course of physical therapy for the employee. Self-insured employers who self handled their workers’ compensation claims need to know how to manage the physical therapy (PT). All employers can benefit from knowing how to manage PT.
Adjuster Physical Therapy Checklist
When the medical provider determines there is a need for physical therapy, the medical provider will advise the adjuster of the diagnosis, the modalities needed and the time frame. The adjuster, in the states where the employer/insurer controls the selection of medical providers, in turn assigns the physical therapy to a therapist provider. In states where the employee selects the medical provider, the medical provider will refer the employee to a therapy clinic of the medical provider’s choice.
Regardless who selects the therapy clinic, the adjuster for the employer needs to do the following:
- Confirm the therapy clinic has the medical provider’s diagnosis and the amount of therapy recommended by the medical provider
- Require the therapy clinic to do an initial physical therapy evaluation during the first visit by the employee and to provide a physical therapy evaluation and treatment plan following the first visit and prior to the second physical therapy visit
- Provide the therapy clinic with billing information and obtain an agreement on whether each individual physical therapy session will be billed or if physical therapy sessions will be billed weekly or monthly
- Discuss with the therapist the estimated time frame until the employee will increase his/her functionality
- Obtain the therapist’s opinion on the possibility of the employee returning to work either full duty or modified duty
- Provide the therapist with a copy of the employee’s job description
- Set up with the therapist a timetable for the adjuster to follow up with the therapist
- The therapy clinic should be instructed to advise the adjuster immediately if the employee cancels a physical therapy session for any reason, or is a no-show
Categories That Should Be Included in Physical Therapy Treatment Plan
When the adjuster receives the physical therapy evaluation and treatment plan following the first visit by the employee, the evaluation and treatment plan should be carefully reviewed. The following information categories should be in the treatment plan:
- The diagnosis of the therapist – it should match the diagnosis of the medical provider. If not, this needs to be addressed right away.
- The employee’s current physical limitations due to the injury
- The employee’s prior medical history and if it will impact the physical therapy, how so?
- The type of modalities the employee will receive
- The frequency of the physical therapy visits per week, and the number of weeks the PT is projected to continue
- The treatment goals and what is expected
- The frequency the therapy clinic will report the employee’s progress to the medical provider
- The self-care guidelines provided to the employee
If any of these categories are missing from the evaluation and treatment plan, the adjuster should discuss with the therapist the need for an addendum to the evaluation and treatment plan that discusses the missed categories.
The initial projections by the medical provider as to how long the employee will need physical therapy are not set in stone. Occasionally the employee will recover faster than expected from the injury and the physical therapy will be discontinued early.
If Additional Treatment is Requested, Consider Utilization Review
Sometimes the employee will recover slower than average resulting in the medical provider extending the requested physical therapy. When extended PT is requested, the adjuster needs to consider the effectiveness of the treatment. If the adjuster has any doubts about the need to continue the physical therapy treatments, the adjuster should arrange for a Utilization Review (UR). If the UR nurse rejects the need for additional physical therapy, the adjuster should ask the Utilization Review nurse to discuss the physical therapy request with the medical provider. If the UR nurse and the medical provider do not reach an agreement on the physical therapy requested, an Independent Medical Examination can assist the adjuster in determining whether to approve additional physical therapy or not.
Managing physical therapy is not difficult. It does take time, however when properly managed the employee’s recovery time is minimized. The PT clinic is an excellent source of information to assist the employer in returning the employee to work on modified duty, or full duty. By working with the therapist, the amount of time the employee is off work is limited to what is necessary.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: firstname.lastname@example.org.
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