When an employee has a musculoskeletal injury keeping them from returning to work, it is routine practice for orthopedic doctors to recommend a physical therapy program. The purpose of the physical therapy program is to assist the injured employee in restoring function, regain a pre-injury level of mobility, control pain, and prevent permanent physical disability. This can be accomplished with physical therapy, providing both range of motion exercises and strengthening exercises.
Members of the claim management team and other interested stakeholders need to understand physical therapy and implement claim handling changes to control program costs. This allows them to control workers’ compensation costs and return the injured employee back to work in a timely manner.
The Basics of Physical Therapy
The doctor treating the injured employee will prescribe the amount of physical therapy that is necessary to restore an injury. Some doctors are very good at estimating the number of physical therapy sessions an injured employee will need, and hopefully, prescribe it accordingly. For instance, the doctor will prescribe physical therapy for the lumbar spine “3 x 4,” which tells the physical therapy facility to treat the injured employee three times per week, for four weeks. The return appointment with the doctor’s office is normally scheduled after the anticipated date of the last physical therapy treatment. This allows the doctor to assess the benefits of the physical therapy treatment program, but it is after the fact.
On the other hand, other medical professionals will prescribe the same amount of physical therapy for just about every patient they see. If every patient is “3 x 4,” or “3 x 6,” some injured employees end up having excessive medical care and treatment. This not only impacts the cost of workers’ compensation claims but does not resolve a work injury in a timely manner. When the injured employee does not get enough physical therapy, they return to the doctor before they have not recovered from their injury. The doctor then prescribes more physical therapy and sets up another return visit to the doctor’s office.
“Results Based” Physical Therapy
When the orthopedic describes physical therapy, the physical therapy facility wanting to ensure payment will normally call the workers’ compensation claim handler for approval. The claim handler may not know whether physical therapy is needed. In many instances the claim handler will not question the need for physical therapy – use the thought process that if the doctor requested it, the care must be needed. This results in the injured employee receiving more physical therapy than needed.
One approach to this dilemma when reviewing a request for physical therapy is to refer the request for to utilization review. Utilization review can eliminate some excessive physical therapy treatment by allowing trained medical professionals to assist in the determination based on the information in the medical notes. Utilization review will not know if the injured employee recovers faster than normal, resulting in the injured employee continuing to go to unreasonable and unnecessary medical care and treatment.
A recent innovation in managing the physical therapy treatment is the development of “results-based” treatment approach. Instead of the injured employee going to the physical therapy office 15 times because the doctor wrote a “3 x 5” script, the injured employee goes to the physical therapy office for as many or as few times needed for the employee to make a proper recovery from their musculoskeletal injury.
In the traditional fee for services model of physical therapy treatment, it is in the financial best interest of the physical therapy facility to continue physical therapy treatment until the doctor sees the injured employee again. This often results in excessive treatment. The results-based approach to physical therapy aligns the interest of the employer and the insurer with the physical therapy facility. A timely recovery and return to work benefits all parties including the employee.
A results-based approach to physical therapy allows a single flat fee for service. It reduces paperwork for the claim handler, by leaving them with only one bill to pay, rather than multiple forms related to ongoing medical care. Results-based physical therapy treatment is also an innovative way for employers and insurers to manage the physical therapy treatment process, and to provide the injured employee with the treatment needed in a timely manner.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a 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 & lead trainer of Amaxx Workers’ Comp Training Center.
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