Mar 5, 2021 | Insights
Early Access to Physical Therapy and Specialty Care Management for American Workers with Musculoskeletal Injuries Study Underscores the Value of Care Management
The multiple benefits of early physical therapy have been documented in recent studies, but this article published in the Journal of Occupational and Environmental Medicine also recognizes the vital role of the care manager – the adjuster, case manager and other claims representative. Phillips et. al analyzed the workers’ comp claims of employees of a large, integrated healthcare system located in the Midwest for the study.
Researchers conducted a retrospective chart review of claims from 2009 that were not managed. These injured workers also received no early access to PT. Their outcomes were compared to those of workers whose claims from 2012 and 2013 were managed through a care pathway, included early access to PT and a high level of communication with all stakeholders. A third cohort was comprised of 2012 claims that were not managed through this path.
The managed path involved an initial visit with a physician and physical medicine provider (PT or occupational therapist) at the same time. If the patient met eligibility criteria, this was immediately followed by a PT evaluation that included an exam, patient education, treatment, home exercise program, referrals, and recommendations for work restrictions, written at the highest levels that would not hinder healing.
The program included seven pre-authorized physical medicine visits. Patients were observed performing core physical job demands during visits, and providers updated written work restrictions accordingly.
The PT or OT met with the physician and study coordinator who served as the care manager every week. They discussed the patient’s progress and any changes to the plan of care.
The care coordinator:
- Was the injured worker’s point of contact
- Communicated with all the providers, making sure everyone had information needed to make care decisions in a timely manner
- Managed all electronic health records
- Provided work restriction updates to Disability Department each week
Results
The managed claims lasting longer than 90 days had lower indemnity costs, fewer therapy visits, and lower total costs of claims than the ones that did not go through the care pathway. Researchers believed the rapid and regular work restriction updates accelerated return to work as did offering to let injured workers voluntarily test their abilities to meet the physical job demands at each session.
Because the study was conducted in a healthcare facility with its own employees and providers, not every employer or payer can control implementation of all the strategies. Yet there are takeaways to explore:
- Heightened communication with all stakeholders
- Pre-authorizing a number of visits
- Patient consultation with a physical therapist prior to treatment
- Identifying and overcoming barriers to early PT
As always, MedRisk stands ready to facilitate early and well-managed PT with our rapid response to referral guarantees, smooth scheduling, PT consultations, and patient education materials. We also have the EDI to quickly transmit electronic health records so our network providers are up to speed on the case before the patient arrives. We have the technology and the resources to help you make early, well-managed PT a reality.
Mar 4, 2021 | Insights
How has telerehabilitation helped physical medicine patients through the pandemic, and what role will it play moving forward?
Delayed recovery has always been a concern for the workers’ comp industry. However, when the pandemic hit last year prompting the cancelation of musculoskeletal surgeries as well as physical therapy treatment, interrupted rehabilitation became a very real threat for injured workers and employers alike.
Fortunately, offerings like MedRisk’s Platinum Grade Telerehabilitation program– launched over three years ago– had already begun to nudge telerehab into the mainstream for injured workers. What momentum did telerehab gain during the pandemic, and what benefits do patients stand to gain from this model as we adjust to a “new normal?”
Telerehab Pre- and Post-COVID-19
Even before the pandemic forced the temporary closure of many physical therapy clinics, getting to and from PT treatment was not always easy for injured workers. Patient location, commute time and level/nature of injury often posed a barrier to appointment compliance. Telerehab was seen as a way to overcome these barriers to care and serve as an alternative to on-site medical treatment.
Historically, state-to-state insurance coverage for telerehab has varied. But during the public health emergency, the Centers for Medicare & Medicaid Services and many states approved the use of telemedicine for physical medicine, at least temporarily – and patients have taken full advantage. MedRisk’s own telerehab numbers increased six-fold between January and April, and utilization has sustained above-average rates throughout the rest of the year.
A Different Goal & Approach
In this CompTalk presented virtually during the 2020 National Workers’ Compensation Conference, Brian Peers, DPT, MBA, MedRisk’s Vice President of Clinical Services and Provider Management describes how MedRisk quickly adapted to the access issue created by the coronavirus.
Before COVID-19, access to PT clinics wasn’t a big issue in the U.S. like it is in other countries that adopted telerehab earlier. Instead, convenience drove most of telerehab’s use. Patients in rural areas used it to avoid long distance commutes to a clinic. Some preferred telerehab to taking more time off work and spending it on the road. In the case of a traveling nurse practitioner who spent every night in a different town, telerehab was the reason she could keep working during her recovery.
When the pandemic created an access issue, MedRisk’s clinical team expanded its telerehab hours and criteria, which had been fairly conservative, to make sure patients had access to care. It turned out that more conditions than originally thought could be successfully treated via telerehab. Outcomes were good and patient satisfaction was high.
For example, Chris B. needed post-surgical PT after a quite involved rotator cuff surgery. Normally, he would start therapy in a clinic, but the clinic was forced to close the day he was supposed to start therapy. Delaying PT could have resulted in long-term mobility deficits and a decreased tolerance for lifting that would have prevented a return to full duty. Telerehab got him through the critical stage until clinics reopened and most of all he said, “I didn’t feel like I was totally out there on my own.”
Another patient needed to avoid clinics to protect her immune-compromised daughter, who was a cancer survivor. The patient could not shower alone, couldn’t stand for more than 5 minutes and had trouble getting out of bed after lumbar surgery following a major crush injury and needed immediate PT. Through telerehab, she progressed to standing during whole visits, lifting 10-15 pounds and being able to walk her dogs. When asked what she liked best about telerehab, she was quick to say, “I felt safe.”
MedRisk patients’ experiences align with the those captured in a recent patient satisfaction study published in The American Journal of Physical Medicine and Rehabilitation. Researchers surveyed patients and patient care advocates for pediatric patients who used telerehab during the pandemic.
Online surveys were completed after participating in a telerehab visit. Participants gave very good to excellent ratings for these areas:
- Addressing my concerns and questions
- Communication with my therapist
- Developing a treatment plan
- Execution of the treatment plan
- Convenience
- Overall visit satisfaction
- Value in having a future telehealth visit
Optional qualitative comments at the end of the surveys showed that respondents appreciated having access to the virtual services, which included physical therapy, occupational therapy and speech therapy.
Clinical Outcomes
For legislators, insurers, employers, and other stakeholders to be convinced of telerehab’s staying power, we need to also consider the clinical effectiveness of this model.
In the field of physical therapy, the utility and effectiveness of telemedicine has been analyzed in recent studies, and according to 2016 research, clinical outcomes associated with telehealth sessions may be equal to that of traditional in-person care services.
The Bini & Mahajan study compared the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient PT to those who participated in PT delivered through an asynchronous video-based tool. The 23 narrated videos created for the study demonstrated the same exercises taught in clinics, were each under 3 minutes in duration and featured on-screen text-based instructions.
On average, study patients engaged with the video-based model reported exercising for a mean of 47 minutes a day. They also logged in 49 times during the study period, posted 9 videos and 5 photographs, and sent 10 messages to their physical therapy providers. And, while patients utilizing the traditional care model logged 11 more minutes of exercise a day, they also reported a mean travel time to appointments of 75 minutes.
Patient satisfaction levels were high among both patient groups, with participants reporting that it was “easy or very easy” to communicate with their physical therapist. On top of this, the study authors write that “clinical outcomes following asynchronous telerehab administered over the web and through a hand-held device were not inferior to those achieved with traditional care,” suggesting that telehealth sessions of this nature are clinically equivalent to the in-person care model.
Conclusion
Telerehab has been proven to be a ready and viable solution during the COVID-19 crisis; however, it is important to remember that a public health emergency is not the only crisis injured workers can face in their recovery. Whether it’s an hour-long drive to the closest PT clinic, an injury that makes it difficult to drive or the weight of family responsibilities, virtual treatment will remain a valuable and cost-effective alternative for ensuring continuity of care for injured workers. For these reasons, industry experts are hopeful that telerehab is finally here to stay.
Feb 4, 2021 | Insights
Non-urgent medical services were suspended across the country in spring 2020 to reserve resources for COVID-19 patients. How is this expected to impact injured worker treatment and associated costs in the long term?
In an unprecedented move for the U.S. health care system, many medical services were halted in spring 2020 to reserve resources for a potential surge of COVID-19 patients. There had been little published on the long-term effects of this on injured workers until the Workers’ Compensation Insurance Rating Bureau of California’s October 2020 report “Cost Impacts of Medical Care Delays in the California Workers’ Compensation System.” In it, the organization analyzed how the suspension of California’s non-urgent medical care in March and April 2020 impacted the state’s workers’ compensation system and its expected influence on claims in the long term.
The study used historical indemnity claim information to examine the implications of first medical service delays on medical and indemnity costs, which were found even four years after injury. The report showed that injured workers with soft tissue injuries whose first medical service was delayed a month had higher indemnity and medical costs that persisted for years. These claims were also more likely to stay open longer, have a longer duration of temporary disability, and involve permanent disability. Similar results were found for other common workers’ compensation diagnoses like low back pain, sprain, and fracture.
Importantly, soft tissue claims with postponed first physical therapy treatment also had significantly higher medical and indemnity costs for years following injury compared to similar claims with no PT delays. These findings reinforce MedRisk’s commitment to helping injured workers receive prompt physical therapy treatment, with an average 4-hour turnaround time from referral to scheduling and just 2.6 days to initial evaluation.
Click here to read the WCIRB’s full report.
Feb 4, 2021 | Insights
A forklift backed up, pinning Toni C. against metal shelving while she was stocking warehouse shelves in March 2019.
The serious crush injury left her with a fractured tailbone, dislocated pelvis and separated pubic bones as well as a hand injury.
Six weeks post-surgery, she donned a mask and gloves and headed to start PT in a clinic that was not in MedRisk’s network. Because she has a teenage daughter who is a cancer survivor with severe immune deficiencies, exposure to COVID-19 was a huge concern.
Her nurse case manager quickly arranged for her to see MedRisk’s Supervisor of Telerehab Services Jill Carnahan, PT, DPT. Learn more about Toni’s story and successful rehabilitation by downloading the full case study here.
Jan 6, 2021 | Insights
Slips and falls, as well as illnesses and injuries caused by cold stress, pose considerable risk to employee health. Here we share tips to help keep your operations running smoothly – and safely – all winter long.
Depending on your business location, winter can bring serious threats to the health and safety of your workforce. In the frosty Midwest, for instance, slips and falls represent one-third of all workers’ compensation claims during winter months. Not only this, but simply working outside during colder temperatures has been shown to increase the prevalence of low back and neck pain.
It is the responsibility of employers to provide a safe working environment for all employees, free of known hazards that are likely to cause serious physical harm. Here are some tips for carrying out this responsibility and supporting your employees’ well-being this winter.
Shield workers from the cold.
Many businesses have mission-critical tasks that require workers to be outside during the winter months; however, there are ways to help mitigate the effects of cold-weather conditions.
Thinking big picture, determine which routine outdoor tasks, like repair or maintenance jobs, can be handled in spring or summer. When drawing up daily schedules, try to limit the amount of time spent outdoors and plan work for the warmest part of the day. If outdoor work is unavoidable on an extremely cold day, think about whether shorter shifts can be accommodated by adding extra workers to the rotation. Give your workers some reprieve by offering sheltered areas to reduce wind chill and supply blast heaters where needed. Employees can also beat the chill by taking breaks indoors and consuming warm beverages throughout the day.
Have a snow maintenance plan.
If not tended to properly, ice and snow can increase the risk of slips and falls for outdoor workers. Before each winter, review and confirm your maintenance plan to apply ice melt or salt to your parking lots, walkways, loading/shipping docks and steps. Lay down mats near entrances to prevent tracked ice, snow and mud and slippery conditions, and if appropriate, consider adding a mudroom or entry room for workers to remove and store boots and outerwear.
Depending on your business’s buildings, rooftop snow removal may also be needed, as overloaded structures can lead to potential collapse. Bear in mind that rooftop snow removal can lead to serious injury in and of itself if not executed safely. Read OSHA’s Snow Removal: Know the Hazards pamphlet for more information.
Keep communications channels open.
Although it’s important to factor forecasts into your operations, there will always be occasions when winter conditions come on suddenly. In these instances, employee communications can be critical, even lifesaving. Have a system in place for monitoring weather conditions and remaining attuned to public announcements related to severe weather (e.g., sirens, radio and television). Likewise, give your employees a phone number to call should they notice sudden winter conditions, become stranded in a company vehicle, or see a hazard such as a downed tree or power line that must be mitigated. And if operations must be suspended or an area is to be evacuated, be sure your communication methods allow you to reach all workers, including those in remote areas.
Empower your employees.
Environmental cold can affect exposed workers and put them at risk of cold stress, which occurs when the body can no longer maintain a normal temperature. And cold stress can lead to cold-related illness or injury, permanent tissue damage, or death. As you train employees in ways to prevent these winter weather ailments, consider the following:
- Workers with hypertension, hypothyroidism, and diabetes are particularly vulnerable, and employees who have been away from work or are new to working in cold temperatures may require more frequent breaks and time to build up a tolerance to colder temperatures.
- While employees are wise to layer loose-fitting clothing during the winter months, wearing bulkier clothing may restrict their movement. Identify potential hazards so you can train your staff on appropriate safety measures. Have safeguards in place on machinery in cases of clothing catching on handles, switches or levers. Train your workers to recognize the signs of cold stress and how to help those who are affected.
- Remind workers of the importance of stretching and physical activity in cold temperatures, which can prevent muscle tension and mitigate the risk of musculoskeletal injury.
Whether your organization’s primary work environment is indoors or outdoors, winter requires planning and vigilance. By taking precautions to minimize illness and injury, you can safeguard the well-being of your workers and maximize operability this winter.
Nov 4, 2020 | Insights
A closer look at how MedRisk technologies and workflows help ensure delayed processes don’t lead to delayed recoveries.
There is no doubt that physical therapy can be instrumental in getting a workers’ compensation patient back on their feet. But what happens when external factors like a shortage of providers or scheduling problems delay the start of treatment?
According to the Workers’ Compensation Research Institute’s latest research, timing is everything – or at least something the industry can’t afford to ignore. Its study, titled “The Timing of Physical Therapy for Low Back Pain: Does It Matter for Workers’ Compensation?” found that PT within 14 days of injury is likely to be beneficial and to be associated with lower utilization of medical services, lower overall medical costs and shorter temporary disability duration.
On top of this, a reduction in diagnostic tests, opioid prescriptions, pain management injections, and lumbar surgeries ultimately lead to faster return to work and lower total costs of claims. The benefits of early PT in workers’ compensation are clear.
So, how can we help ensure injured worker treatment begins stat? Here are three ways MedRisk facilitates early PT for your injured workers.
1. A Robust Provider Network
A lack of provider availability can be a big hurdle to timely treatment. One week, a patient may need a carpal tunnel specialist in a rural area while the next case requires an aqua specialist in an overbooked urban district. MedRisk’s large nationwide network has a range of PT providers – both in terms of geography and specialty. When other, smaller networks cannot meet case requirements or do not have a provider close to the patient’s home or workplace, cold calls need to be made to recruit a PT willing to take a given case. That can add days or even weeks to the process. Instead, our patient advocates schedule a patient with a provider based on their location and treatment needs within 4 hours. This helps patients be seen for an initial evaluation within 2.6 days of referral on average.
2. Technology-Backed Workflows
As described above, having a large network – and one with specialists – is integral to fulfilling a case request. But when it comes to finding the right provider at the right time, there’s more to it than having a large rolodex of names to choose from.
MedRisk’s technology ensures that a patient is matched to the most appropriate provider based on their unique needs, using criteria that go well beyond demographics and cost. Our selection process is data-driven: on the patient side, by injury type, chronicity and complexity, and on the provider side, outcomes by injury type, compliance with evidence-based guidelines, patient satisfaction and more.
Our advanced technology rapidly sifts through all of that data to present the patient advocate and the patient with a near-instant selection of the local best providers for his or her condition.
Accelerated time-to-treatment is further facilitated through MedRisk’s electronic data interchange (EDI) with insurers and other payer organizations. With EDI, patient and claim referral data pre-populates in our database, so that when the adjuster makes the referral, our patient advocates already have everything they need to schedule an appointment and that same critical information can be instantly faxed to the provider.
In states that require utilization review (UR) prior to PT, additional integration with the payers’ UR partner(s), keeps MedRisk and the adjuster informed at the same time. No need for time-consuming phone calls or emails verifying the results of the UR decision.
MedRisk has the technology, expertise–and most importantly–the resources to manage the heavy lifting in setting up the EDI.
Even when clients choose not to have EDI, we can help them implement fast referral functionality so they can refer a case with the click of a single key without exiting their claims system or picking up the phone.
Beyond these technologies, thoughtful workflows are critical to keeping referral and treatment processes on track and clinically sound. At MedRisk, we use evidence-based guidelines as our clinical foundation and have also developed historical data sets to help us identify trends that call for custom workflows. These proactive processes help us avoid delays in time to treatment.
3. A Commitment to Patient Advocacy
Injured workers are already facing physical challenges due to their injury. They may also be feeling anxious and fearful about their treatment and recovery.
Patients can receive a PT Consult prior to treatment with the goal of setting expectations, addressing fears and education about their injury and treatment.
In addition to their commitment to timely scheduling, MedRisk’s patient advocates text reminders and driving directions to help minimize no-shows, which could otherwise add 1-3 days to the start of treatment. All this can go a long way in encouraging a patient’s participation – and with it, a speedy recovery.
Conclusion
Service-oriented programs can help facilitate the timeliness of PT treatment, but at the end of the day, early PT begins with a timely referral. MedRisk has the know-how to integrate your systems to receive cases automatically – and the clinical expertise and network coverage to give them the appropriate, timely treatment they deserve.
