Good PT Is Great Rx
MedRisk is a provider of managed physical medicine for the workers compensation industry. The organization, based in King of Prussia, Pennsylvania, manages physical and occupational therapy as well as other modes of treatment to improve care and reduce workers compensation costs. O’Donoghue discusses a recent MedRisk report on how improved care management can reduce pain points in the workers compensation process.
When possible, we opt for conservative therapy first. One initiative we have embarked on is the use of a pre-treatment consultation to help with this. It’s about 20 to 30 minutes where we listen to the patient, talk about conservative therapy and different ways to deliver it that make it convenient for the worker.
The conversation includes a couple of things. Patients should understand they have a prescription for physical therapy [PT] for their condition, which a majority of patients end up having. We let them know that most people don’t need to jump to surgery—that imaging and conservative treatment is effective.
We perform a psychosocial screening. This is an opportunity to uncover things that might be a barrier for someone returning to work. It’s an evidence-based tool that helps get to things like a history of anxiety or depression, things that were there already but might be a hurdle for them getting back. Someone might have a comorbid condition or have trouble getting to therapy. We had one injured worker who was prescribed pool therapy, but she had no interest in putting on a swimsuit and getting in a pool.
It’s the discovery component, and there are a lot of carriers out there that have this in their process. If we can identify some of these factors up front, we can let the nurse or treating physical therapist know, and they can cover it during treatment.
Generally, there are more advanced surgical interventions that are driving speedier recovery time and less PT after surgery for things like carpal tunnel. There are also some more aggressive postsurgical rehab protocols which can get patients in and out of PT faster.
There is also a huge push in workers comp toward value-based care. You are seeing it in general health and PT a lot. Those industries are far more outcomes-based in recent years, partially because of Medicare. And that is helping move PT and workers comp into that mindset as well. There are already some provider groups, like orthopedic surgeons, that have some value-based arrangements that do include physical therapy. It’s headed there; what happens in general healthcare tends to come over to workers comp as well.
We work with third-party administrators, carriers, and large employers to manage their physical therapy. Our role is to help them find the right provider and ensure the injured worker is going to providers that are in-network. We provide them some insights into treatment strategies; sometimes the workers comp adjuster or nurses might not be an expert in PT. We have our own proprietary set of evidence-based guidelines to follow for treatment that is appropriate and medically necessary.
When a referral comes in, we make sure it is the appropriate prescription and compare it with our guidelines. Then, we provide oversight to make sure the patient is staying on track. If we feel it’s not going well, we have a group of in-house PTs to work with the treating physical therapist, adjuster, nurse and physician to get it back on track. The payments are in the hands of the insurer—we just give guidance.
If someone has missed appointments, we will sometimes reach out to see if they can’t get there and offer telerehab instead. It’s been a great additional option for injured workers. Those that make it through the finish line have really benefitted from it; they have fewer visits, but they are very engaged.
Surprisingly, it’s not necessarily the younger population or those that are tech-savvy who like it. The group where we have the largest percentage of folks using it is around ages 45-54. They probably embrace it because they can do it from almost anywhere—on the worksite, in hotel rooms.
We can offer it if someone is willing, has their head in the game, is motivated and has the right technology. And there’s some fluidity between the clinic and video. We can offer the option that is convenient for them. People have an average of 30 minutes of dedicated time with a PT and can also go to a portal for education and videos. Those that go through a hybrid model will have fewer visits per claim.
We are also working on providing on-site, telemedicine PT services at an employer’s location. A business that has a lot of volume could be supplemented with a video terminal so patients wouldn’t miss time from work. All they need is a room that is private with some space to move around.
Keep in mind there is a pretty intense screening process that has to be done by a physical therapist before someone can even consider using telerehab. We don’t use it for things like head or jaw injuries, and they can’t have an active infection or inflammation and must have stable balance.
Some of our messaging to brokers and employers is about making sure they are aware that PT for workers comp is a big part of their medical spend—about 20% generally. It’s really important, especially in industries with higher rates of injuries, that brokers are placing employers in programs that are strong on the PT side. They need big networks that can cover large geographic areas and are focused on value and are outcome oriented. Brokers shouldn’t overlook this area, because it can drive other medical spending down in places like surgery and opioid prescriptions.
They need to seek vendors with high-value service that are employing PT appropriately. The difference between functional recovery and disability is appropriate referral to physical therapy. It has to be timely and evidence-based and collaborative, and it should be informed by psychology as well so they know if there are other issues going on.
Physical therapy also has to be outcome based. They can’t just send people to PT without goals. They need to make sure the injured workers take responsibility for their compliance or it won’t work. There is a whole process around that, and you have to have those components.