Using Results-Based Physical Therapy to Control Workers’ Comp Costs

results based physical therapyWhen 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.

 

 

Conclusions

 

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.

 

 

 

Michael Stack - AmaxxAuthor 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 .

 

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

 

©2019 Amaxx LLC. 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.

Leverage Physical Therapy Checklist To Return Employees To Work

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: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. 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.

 

Working With A QRC In Workers’ Compensation

Qualified Rehabilitation Consultants (QRC) play an important role in workers’ compensation vocational rehabilitation programs.  It is important to members of the claim management team to understand the proper role of a QRC or other vocational assistance representative and how to avoid problems with their involvement in a claim.

 

 

What is a QRC?

 

A QRC is the term used in most state workers’ compensation programs for a vocational expert who assists an injured party navigate the complexities of the medical and rehabilitation aspects of their industrial injury.  In most instances, the QRC is a neutral party who has a unique background that includes social work activities, human resources or nursing. 

 

The activities a QRC can perform vary.  The most frequent use of a QRC is to assist an employee with job search activities.  This can include simple tasks such as preparing a resume or interview.  It can also include going to a doctor’s office appointment and asking questions the injured person might not be prepared to ask.  In essence, they are the “jack of all trades” in the workers’ compensation system.

 

 

QRC Selection and Reporting

 

In most jurisdictions, it is the right of the employee to select a QRC once they qualify or vocational rehabilitation services.   Regardless of who has the right to select the QRC, there are limitations as to how a change in QRC can take place and when this can occur.  It is often true that specific paperwork needs to be prepared and filed with a workers’ compensation division on all matters of QRC selection and change.

 

Once a QRC is selected, it is important to have an open line of communication with this individual.  Some of the common required communications from a QRC include:

 

  • Scheduled status reports.  This will include information on activities and meetings held with or on behalf of the employee, including information on their progress toward return to work and maximum medical improvement;
  • Required state forms.  This often includes statutory requirements on proposed future activities, costs and other relevant information with the vocational rehabilitation process;
  • Ongoing job search efforts and activities by the employee.  Failure to conduct a diligent job search can result in the loss or suspension of various indemnity benefits.

 

Additional Resource:

Your Ultimate Guide To Mastering Workers Comp Excerpt …Rehabing the Injured Employee & The Three Indications of When to Use Vocational Rehab

 

Role of a QRC

 

The role of a QRC is typically set forth in statute or rule.  Some of the more important rules generally include what role, if any, the QRC can perform as an advocate for the injured party.  This area is often a flashpoint of contention and dispute in the workers ’ compensation process.  A QRC is often prohibited from performing some of the following activities:

 

  • Claim investigation or participating in surveillance;
  • Recommending entitlement to future workers’ compensation benefits;
  • Authorizing or providing comment on the necessity of future medical care and treatment
  • Assisting with or being a part of settlement negotiations; and
  • Setting up future medical appointments or examinations.

 

 

Working with a QRC

 

As a member of the claim management team, it is important to have a professional relationship with a QRC.  Some best practices may include developing an open line of communication with a QRC.  It may also help by going beyond an “open door” mentality with a QRC by offering to meet at a convenient location for the QRC to discuss a claim.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Employers/Carriers/TPAs/Brokers/Vendors looking for additional information FREE resources for Workers Comp cost containment best practices are invited to access Amaxx Workers’ Comp Cost Containment Essentials training series

 

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

 

A Physical Therapist Does More Than Just Rehab

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:

 

  1. 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.

 

 

  1. 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.

 

 

  1. Show the therapist your light duty/full duty work jobs so they can gear rehab towards 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.

 

 

  1. 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.

 

 

  1. 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.

 

 

Summary

 

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: mstack@reduceyourworkerscomp.com.

 

©2013 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.

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.

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