Feb 4, 2020 | Insights
How has MedRisk’s telerehab program increased access and engagement for injured workers? Director of Clinical Services Brian Peers, DPT, shares his insights.
From DIY home improvement videos to virtual mental health services, online platforms have changed the way we get professional help when we need it. It should, therefore, be no surprise that technology has infiltrated the world of rehabilitation. However, MedRisk’s Telerehabilitation Program isn’t just about jumping on the bandwagon of a popular fad – the idea was born out of the needs of the injured worker.
For more than 25 years, MedRisk has been the liaison among patients, providers and payers. Now, for the first time, MedRisk is leveraging HIPAA-compliant, secure videoconferencing technology to help busy and clinically eligible patients take advantage of the convenience that a virtual rehabilitation program can provide.
How has the telerehabilitation program changed the return-to-work journey for MedRisk-referred patients? We sat down with MedRisk’s Director of Clinical Services Brian Peers, DPT, to get a closer look.
Traditional Vs. Telerehab
Traditionally, recovery from a worker’s comp injury has involved several trips to a brick-and-mortar PT clinic prior to discharge; however, MedRisk’s virtual tools and therapeutic methodology now make it possible for some or all of injured worker treatment to be completed virtually, from just about anywhere.
In order for patients to be eligible to participate in the telerehab program, they must meet MedRisk’s three-pronged enrollment criteria. According to Peers, they must be “ready,” meaning they have the technology and skills needed to access and utilize the online platform. They must also be “willing” – that is, they must express an interest in participating. And, finally, they must be deemed “able” to take part in the program, based on a clinical assessment of the type and severity of their injury as well as the nature of their treatment plan.
Increasing Patient Engagement
There are some injuries for which in-person physical therapy will always be necessary; however, as the program’s track record shows, for many patients, treatment does not need to be on-site in order to be engaging and effective.
Perhaps the biggest advantage for telerehab patients is the undivided attention they receive from a dedicated PT in their sessions. With telerehab, there are no other patients in the room; therapy is one-on-one. This enhanced level of support allows therapists to ensure compliance throughout the duration of treatment and help engage and encourage patients as they regain their strength. The platform also offers a virtual “open door” to a physical therapist should any questions or concerns arise.
“When you go to your primary care doctor, you typically have an exam, and then maybe your doctor asks, ‘Is there anything else I can help you with?’ This is the most impactful part of the experience because you can say ‘Well, my neighbor told me…’ or ‘What would happen if …?” Likewise, for the injured worker, we are finding the most valuable benefit of telerehab, in addition to the technical instruction, is that one-on-one time with their therapist. With telerehab, patients have that ‘facetime’ for the whole visit,” Peers said.
In addition to live video conferencing, patients benefit from customized exercise assignments, a video library and resources available within the platform’s online portal throughout guided therapy and in between appointments. They can log their exercises, view notes from a recent session, schedule a virtual “face-to-face” visit, and communicate with their MedRisk provider through secure messaging.
“Initially, a patient may be very dependent on the therapist; however, as treatment progresses, it’s about making sure the patient has a clear understanding of their condition and how to independently manage it. Telerehab allows us to engage with the patient during this period when recovery becomes a more active process.”
Program Outcomes
Feedback from the program’s first two years has been overwhelmingly positive. It has a 95% satisfaction rate, with patients citing “convenience” and “1:1 time with the therapist” as top benefits of the program. A blended model of in-clinic care and telerehab shows 20-35% savings compared to comparable claims, and patients have seen up to a 36% decrease in duration of care over standard treatment.
In fact, the program has generated such interest that MedRisk now offers large employers the option of staffing large facilities with a MedRisk PT trained in delivering care via live video-conferencing. This onsite PT is trained in the employer safety protocols so they can deliver in-person therapy at the company’s home office as well as deliver consistent care to employees at smaller satellite offices via the telerehabilitation platform.
“It’s been gratifying to witness the success of the program,” Peer said. “We are hearing from patients, ‘I wish I had done this sooner.’ I think it’s fair to say it’s working, and it’s working better than any of us had ever expected.”
Nov 1, 2019 | Insights
Research has shown that fear, anxiety and other psychosocial factors can be barriers to recovery in injured workers. How should PTs go about factoring these concerns into their treatment plans? MedRisk Advisory Board member Chris J. Main, PhD, weighs in.
MedRisk ISAB member Chris J. Main, PhD, has had an interest in musculoskeletal pain and disability for more than 40 years, but becoming an authority on the subject was not a deliberate plan. According to Main, his expertise in the bio-psychosocial approach to pain management is a culmination of experience in a diverse range of settings.
Main initially began working in orthopaedic surgery in Glasgow, UK, before gaining experience at a tertiary pain clinic in Manchester, UK. Over the course of this time, he recognized the bearing that fear, catastrophizing, and other psychosocial factors can have on the rehabilitation process. At the same time, he saw no formalized clinical framework for proactively addressing the issue.
“Some pain management techniques that were developed originally in the rehabilitation of chronic pain disability are being used as a means of secondary prevention. However, adoption is in its early stages,” Main said.
He is hoping some traction can be gained through his research at Keele University, where he has been working to link psychosocial screening for chronicity with target treatment. The goal is to provide a standard protocol for PTs and other clinicians to identify psychosocial barriers to recovery so they can address them early, ideally preventing chronicity, which often includes delayed return to work (RTW) in the case of injured workers.
Such an approach was studied by Main and fellow researchers from around the globe, who evaluated the effect of a psychosocial intervention protocol on Australian workers with soft tissue injuries. In the intervention group, workers were screened within 1-3 weeks of injury using the Örebro Musculoskeletal Pain Screening Questionnaire, short version (ÖMPSQ-SF) – the same questionnaire that is utilized by MedRisk staffers during PT consult prior to treatment. Those identified as being at high risk of delayed RTW were offered psychological assessment and a comprehensive protocol to address the identified RTW obstacles. Similarly identified injured workers in the control group were managed under usual (stepped) care arrangements.
At 2-year follow-up, the mean lost workdays for the intervention group was less than half than that of the control group. In addition, their claims’ costs were 30% lower, as was the growth trajectory of their costs after 11 months.
“Our findings supported our hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace risk factors for delayed return to work, can achieve better return on investment than usual (stepped) care,” Main said.
According to Main, outcomes like this are garnering attention from the physical medicine community; however, opportunities for training have remained limited. Recognizing this need, Main is assisting colleagues at Duke University in developing a new training program that uses psychologically informed practice (PiP) as a general framework and emphasizes the nature of communication with the patient as a key component. He sees opportunity for this approach to be harnessed in workers’ compensation as well.
“I believe it has the potential to significantly change the outcome of interventions with tangible benefits to payers and providers as well as injured workers,” he said.
Oct 4, 2019 | Insights
Chief Clinical and Product Officer Mary O’Donoghue shares why a consultation with an on-staff physical therapist prior to treatment is a critical component of MedRisk’s Platinum Grade Program for Managed Physical Medicine.
It’s a well-known fact that physical therapy as first-line treatment can improve patient outcomes, but what about a consultation with a physical therapist? Can a simple conversation between patient and provider in advance of treatment affect outcomes?
Research says yes. A 2018 study from the University of Utah found that a discussion between patient and provider about the severity of pain and prognosis can reduce the chance of opioid prescription by up to 65%. And according to MedRisk Chief Clinical and Product Officer Mary O’Donoghue, the benefits don’t stop there. In this article, we take a closer look at what physical therapy (PT) consultation entails at MedRisk and three ways this important touchpoint can benefit injured workers.
1. Educate the Patient
Patients directed to the MedRisk network for physical rehabilitation receive a clinical phone consultation with one of MedRisk’s on-staff physical therapists prior to scheduling and before the start of treatment. One of the objectives of the call is to educate the injured worker on why physical therapy is valuable, what to expect and the importance of active engagement and compliance with the treatment plan. Individualized coaching is also provided for the specific diagnosis, such as low back pain or shoulder injury, to reassure patients that in most cases, conservative care (including PT) will relieve.
Altogether, the consultation is intended to support a reduction in appointment no-shows and cancellations, better compliance with at-home exercise, a lower rate of opioid prescription and a decrease in medical costs.
“We’re finding with the level of patient engagement that can be cultivated during these calls,” O’Donoghue said.
2. Address Psychosocial Factors
According to O’Donoghue patient education can mitigate the fear and anxiety that often comes with a work-related injury. But the PT consult goes a step further to address catastrophic thinking and other negative factors that may also be at play following an occupational injury.
MedRisk’s physical therapists use the opportunity to help allay worry and set expectations.
“The patient may have a run-of-the-mill diagnosis, but if during the consultation the patient indicates that she is afraid of re-injury then it might be an opportunity to apply additional resources to the case, such as a nurse case manager to potentially avoid delayed recovery down the road,” O’Donoghue said.
3. Introduce Telerehabilitation
During the consultation, MedRisk physical therapists have an opportunity to better understand a patient’s unique needs. For instance, do they travel for work? How far are they from the closest clinic? If the patient is identified as clinically eligible for telerehabilitation, it is discussed as an option during the consultation.
MedRisk’s telerehabilitation program takes a blended approach to treatment consisting of telerehabilitation, traditional clinic delivery and fluidity between these two service delivery options. Using advanced HIPAA-compliant technology, a US-based MedRisk clinician can connect instantly with the patient for face-to-face evaluations and coaching. Treatment may also be supported by MedRisk’s dynamic library of instructional videos and “store-and-forward” materials to facilitate patient education and improve satisfaction. Remote patient monitoring for guided home exercises is also available to capture and summarize clinical data on performance, progress and compliance to maximize care management.
“Sometimes it’s the people you least expect who are eager to try it. One of our first telerehab patients back in 2017 was 62 years old,” O’Donoghue said. “Many travel for work, and we ask them if there’s a hotel room or conference room available to them. As long as the injured worker has a private, appropriate place to participate in therapy and they are comfortable with the technology available, we can be successful in delivering PT.”
Conclusion
When a worker gets injured on the job, they may not know much about the road ahead of them, especially if it is their first injury. Connecting with a physical therapist before visiting the clinic can help patients gain a sense of understanding and control in what can initially seem like a hopeless situation.
“You just never know how a patient is feeling. If they are disengaged or have already made up their mind that are not going to get better, treatment will be an uphill battle. This could end up being the most important appointment they have,” O’Donoghue said.
Oct 3, 2019 | Insights
Which psychometric tools can help physical therapists identify psychosocial barriers to recovery? A recent article offers recommendations.
Physical therapy has increasingly become the first-line therapy for musculoskeletal injury; however, PTs vary significantly in their approach to identifying risk factors for chronic pain and disability. Research suggests that the most important prognostic factors are psychosocial and can include depression, anxiety, fear of reinjury and pain catastrophizing.
A 2019 article published in the Journal of Applied Biobehavioral Research reviewed six psychometric tools and made recommendations for how and when they might best be employed in a physical therapy setting.
The authors’ review covered the following psychometric tools:
- Multidimensional psychosocial assessment tools
- Keele Subgroups for Targeted Treatment Back Screening Tool: a nine‐item tool that can be particularly useful in stratifying risk for lower back pain (LBP) patients
- Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO‐YF): a streamlined 17‐item questionnaire to help determine the presence of specific yellow flags in patients presenting for PT intervention
- Unidimensional psychosocial assessment tools
- Pain Catastrophizing Scale (PCS): originally developed for use with healthy individuals, this 13‐item questionnaire PCS has been primarily studied in patients presenting to outpatient PT and in the orthopedic postsurgical setting
- Tampa Scale of Kinesiophobia: developed to measure fear of movement in chronic pain patients presenting for behavioral rehabilitation; used in acute LBP and other acute pain populations
- Pain Self‐Efficacy Questionnaire: a 10-item questionnaire developed to measure an individual’s beliefs about their ability to participate in social activity and accomplish their goals in light of pain; originally used with chronic LBP patients, now validated for patients with chronic neck pain, upper limb pain, lower limb pain and fibromyalgia
- Patient Health Questionnaire: a nine‐item questionnaire that measures the severity of an individual’s depression based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) criteria
The authors assert that these clinical tools may provide important prognosis insights and help inform PTs on whether a psychologically-informed treatment platform is indicated. Likewise, MedRisk is dedicated to helping PTs determine if yellow flags are contributing factors in patient presentation and uses the Orebro Short Form (OMPSQ-SF) during PT consultation with injured workers in advance of scheduling.
Click here to read the complete article.
Van Wyngaarden JJ, Noehren B, Archer KR. Assessing psychosocial profile in the physical therapy setting. J Appl Behav Res. 2019;24:e12165. https://doi.org/10.1111/jabr.12165
Jul 29, 2019 | Insights
A 2019 systemic review of high-quality clinical practice guidelines has yielded a set of 11 key recommendations for best-practice musculoskeletal treatment – all of which have been historically supported by the MedRisk Platinum Grade Program for Physical Medicine.
In a recent article published in the British Journal of Sports Medicine, a multidisciplinary research team identified 11 clinical practice guideline (CPG) recommendations for treating adult musculoskeletal pain. The recommendations are the product of a systemic review of 44 CPGs addressing spinal pain, hip/knee pain and shoulder pain. The authors contend that practice aligned with these guidelines results in “better outcomes and lower costs;” however, there can be barriers to integrating the recommendations into daily practice, including a lack of guidance for implementation.
As a leading physical medicine managed care organization, MedRisk works to close these “evidence-to-practice gaps” by supporting our expert providers with patient-centered services, education and our own evidence-based guidelines focused on rehabilitating the injured worker.
In this article, we take a closer look at the study authors’ 11 recommendations and how they are addressed by the MedRisk Platinum Grade Program for Managed Physical Medicine.
Patient-Centered Services
Fittingly, the first recommendation from the study authors is “Care should always be patient-centered.” The dedicated physical therapists (PTs) in our provider network live this principle every day in the treatment they provide, and MedRisk helps facilitate patient-centered care as soon as a case hits our desk. Our representatives use a dynamic scheduling algorithm to match patients with a provider who is equipped to meet their treatment needs and who can see them as soon as possible.
Many providers routinely conduct an assessment that includes a physical examination (Recommendation 5) and screening for “red flag” conditions (Recommendation 2) at the start of treatment. But even before the initial evaluation, MedRisk’s on-staff PTs first conduct a phone consultation. The conversation helps identify psychosocial factors like anxiety and catastrophic thinking (Recommendation 3) that may be a roadblock to recovery. After this initial interaction, the MedRisk PT can help facilitate better understanding and communications about the patient’s unique case in advance of the physical evaluation and treatment.
This phone consultation is also used as an opportunity to educate patients about their condition and treatment (Recommendation 7). Patients learn about next steps in their rehabilitation and the important role they play as an active participant in the recovery process. When applicable, this can include a discussion of why exercise and physical activity is often a key component of treatment, as discussed in Recommendation 8. Should the patient be identified as an ideal candidate, a MedRisk PT will also present the option of the MedRisk Telerehabilitation Program, which can support the patient’s transition to independence and help ensure compliance with exercises prescribed during treatment.
MedRisk’s Evidence-Based Treatment Guidelines
Recommendation 11 from the study authors states that “treatment should facilitate return to work” and encourage patients to remain active and engaged throughout their recovery. MedRisk supports successful return to work with the only evidence-based guidelines in the industry specific to physical medicine and the injured worker. These proprietary guidelines are continuously updated to incorporate new research in the field, including developments related to therapies, comorbidities, psychosocial factors and barriers to recovery. For example, the study authors’ ninth recommendation is “Manual therapy should be used only as an adjunct treatment,” and manual therapy and the application of other modalities are detailed in the MedRisk guidelines.
Throughout treatment, MedRisk takes an active role in monitoring progress and facilitating communication between providers and case manager/adjusters so that as patients are benchmarked against “validated outcome measures” (Recommendation 6), all parties can ensure the injured worker is on track with their current treatment plan.
Knowledge Sharing
Research in the field of physical medicine continues to yield new approaches and emerging therapies. MedRisk keeps a pulse on these developments and disseminates content regularly to our provider network. In recent years, growing evidence has led the industry to promote nonsurgical care as first-line treatment (Recommendation 10). This finding has been promoted in MedRisk study spotlights and newsletter articles. Likewise, the study authors advise against the use of radiological imaging except when a serious pathology is suspected (Recommendation 4) – which is an approach we have also promoted to our provider network.
MedRisk aims to share leading-edge research and to incorporate the latest evidence-based findings into our operations. The fact that our programs and services align with these 11 core recommendations suggests that our Platinum Grade Program for Managed Physical Medicine delivers what constitutes high-quality musculoskeletal care.
To learn more about this study and related recommendations, click here.
Jul 2, 2019 | Insights
Are your employees at risk of these common hot-weather hazards?
When it comes to summer occupational hazards, you might think your employees are not among those at risk. Heat stroke is something only farmers and construction crews need to worry about, right? But according to the Bureau of Labor Statistics (BLS), your employees might not be as protected as you think.
Of the 2,490 cases of nonfatal heat-related injury or illness requiring time away from work in 2017, cases were roughly split among Goods-Producing Industries (1,270 cases) like agriculture, forestry, mining, construction and manufacturing and Service-Providing Industries (1,220 cases) such as trade, transportation, utilities and warehousing. The top 5 occupations affected also held some surprises: not only construction but extraction; transportation and material moving; service; production; and installation, maintenance and repair.
These data show that no business is immune to hot-weather hazards. What risks do summer conditions pose to your workforce, and how can you get ahead of them?
1. Heat-Related Illness
The risk for heat-related illness doesn’t always rise at the same pace as mercury in a thermometer. That’s why the Occupational Safety and Health Association uses heat index in defining its four levels of risk. Organizations looking to create a heat illness prevention plan can refer to OSHA.gov, where you’ll find recommendations for protective measures at each level. These range from providing water and sunscreen to workers on lower level days to ceasing nonessential tasks and monitoring physiological symptoms on days of extreme risk. Once formalized, managers should be trained to implement the plan but also to be watchful for employees who may benefit from added precaution, such as those who have returned to work recently or who may not have built up a tolerance to hot weather conditions.
2. Tickborne Disease
Insects, arachnids and mites caused 3,770 cases of nonfatal occupational injuries and illnesses involving time away from work in 2017. According to the BLS, the service industries, including education and health services and trade, transportation and utilities among others, were particularly at risk (3,140 cases).
May, June and July are the most active months for ticks that transmit Lyme disease, according to the Centers for Disease Control and Prevention. Ticks are drawn to landscapes with bushes, leaves and high grass, so when working outdoors, it is best for workers to avoid these areas whenever possible. If employees are working in an area where ticks could be present, the CDC advises that they cover as much skin as possible by wearing long pants and a long-sleeved shirt as well as tucking their socks into their boots. Some even tape their pants and socks together for an added barrier of protection.
Following their shift, workers are advised to inspect their entire bodies for overlooked ticks. Ticks can be removed with tweezers, and if caught within 24 hours, the risk of Lyme disease is relatively small. However, it is important to monitor for signs and symptoms of untreated Lyme disease, such as fever, rash, facial paralysis, and arthritis, and to seek medical attention as needed. Clothes should be washed in hot water and dried on high heat for an hour to kill any ticks that may have been missed. The CDC also suggests treating work clothes with Permethrin, a tick repellent (note: this should never be used on your skin directly).
3. Flooding
Flooding is most common in warmer months of the year, and since 2015, more than 100 people have died annually because of floods.
For anyone who works in an area prone to flooding, this makes it critical to identify a safe location to go should waters rise. Authorities also advise that workers be provided a radio to keep on hand at job sites so they can be alerted to evacuation orders should an emergency arise. In case of flood, workers should cease operation of any electrical equipment as it presents a risk of electrocution if it gets wet or is operated while standing in water. If a worker is trapped in a building as the water rises, they should be trained to go the highest level possible, using the roof only if necessary. If trapped in a vehicle in fast-moving water, it is advised that they stay inside the vehicle and relocate to the roof if waters rise in the vehicle.
Conclusion
As global temperatures rise, stronger storms become the new normal and tickborne disease rates increase, employers must become more proactive in guarding against illnesses and injuries that can occur in summer months. No matter your industry, take the time to review your plans and policies so your workers are equipped to remain safe and cool as summer heats up, and year-round.
