Mar 14, 2017 | Insights
When savings have plateaued, a new approach to cost containment that applies outcome-driven analysis and clinical expertise may be in order.
While traditional bill review catches the vast majority of issues and has resulted in myriad cost reductions, payers are still missing out on an estimated $3.5 million in savings for every $100 million in medical charges.
Luckily, a new system for medical cost containment has been unveiled and it has the potential to provide aggressive savings above what is currently being achieved.
NexGen Advantage℠ is the industry’s first single solution that uses analytics, technology, and clinical expertise to ensure accurate and fair medical payment of each and every bill. Employed post-bill review, this new solution is designed to maximize medical cost containment specifically for the workers’ comp industry. Here’s how:
Calculates complexities
Common bill review catches a lot of errors, but most systems are not set up to do a deep dive. Bill codes are assessed using software and triggers that are programmed to primarily look for coding conflicts that indicate errors. For example, if it’s a workers’ comp bill, why is there a code for a thyroid scan on here?
Complex cases, however, are not always this clear or straightforward and can slip through the cracks. The NexGen system relies on nuanced algorithms, leveraging over 200 million code combinations from the group health industry to maximize savings by recognizing complex bill patterns that may require clinical intervention.
Includes Peer-to-Peer Clinical Conversations
Approximately 70% of flagged billing issues require some kind knowledgeable human assessment. Whether it’s complex coding errors like “return to surgery” at a physician’s office, or suspicious billing patterns like a patient with 17 facet joint injections being billed in a single year, only peer-to-peer evaluation by a physician or expert coder can determine if these bills are clinically appropriate.
NexGen Advantage employs peer-to-peer conversations with providers about benchmarks, coding and payments, and offers online access to data that helps all parties engage in non-confrontational discussions to arrive at the right decision.
Strategic discount arrangements
In-network discounts don’t always result in the greatest savings available and often come with complicated stacking structures and hidden access fees; out of network solutions add vendor management burdens and even more access fees. NexGen Advantage assesses the potential savings possible across all channels at once–appropriateness of charges, network rates, benchmarked costs and whether negotiation is possible and desirable–to apply the most advantageous discount arrangement possible.
Ready to break through the savings ceiling and realize more streamlined, more efficient results and payment integrity? Learn more about MedRisk’s NexGen.
Mar 7, 2017 | Insights
How can telehealth capabilities help injured workers along the road to recovery?
For workers who unexpectedly become injured and cannot resume their professional functions, getting to and from appointments has historically been a challenge. Until now.
Advanced telemedicine capabilities are beginning to transform the workers’ compensation industry, providing injured workers with a much-needed alternative to on-site medical care. Workers’ compensation professionals generally define telehealth as a virtual interaction involving multiple parties in the claims process. Some consider telephone communications between injured workers and nurse case managers to be an example of early telehealth at work. However, in recent years, the definition has come to encompass more clinical services, such as virtual face-to-face interactions and the remote measurement of vital signs.
Clinical Outcomes
Following an injured worker’s initial diagnosis and the creation of the doctor’s first report, follow-up visits are generally conducted every 45 days. In some cases, these visits are largely hands-off, and a time for the worker and their provider to discuss how treatment is progressing. This is one example of the 70 percent of clinical encounters that can be successfully performed through telemedicine without an on-site clinic visit, according to the American Medical Association.
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 set out to compare the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient physical therapy to those who participated in physical therapy 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 telerehabilitation 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.
Practical Benefits
There are several situations when an injured worker’s access to care would be greatly enhanced by telemedicine capabilities. For instance, if a manufacturing employee injured himself or herself while working an overnight shift, the only other option may be to visit an emergency department for evaluation. Or, if a truck driver sustains an injury while on the road, the closest clinic may be at a remote location. Under these circumstances, telemedicine may prove to be an advantageous resource for immediate assessment.
In addition to initial injury evaluations, follow-up appointments such as post-operative visits and second surgical opinions, may be handled through telemedicine technologies. Remote patient monitoring technologies can also allow healthcare providers to monitor complex, high-risk conditions and remain attuned to a patient’s progress and recovery to help prevent re-injury, complication, or delays in treatment.
Considering these positive effects, telehealth-powered care models have the potential to save both time and money for patients and employers alike. It’s true that not every injured worker may be an ideal candidate for telemedicine – and in some circumstances, there is simply no replacement for hands-on care – but any resource than can alleviate obstacles for even a subset of injured workers while upholding exceptional clinical standards is certainly worthy of consideration.
Feb 6, 2017 | Insights
Arthroscopic partial meniscectomy is a procedure used to treat as many as 300 in 100,000 US patients annually.
While a heavily relied upon intervention, knee arthroscopy has been associated with short-lived and sometimes inconsequential benefit but additional harms. In fact, only 1 in 5 previously conducted randomized controlled trials found that partial meniscectomy resulted in greater pain relief compared with non-surgical treatment one year post surgery.
Now, new research out of Norway is positing that exercise therapy and knee arthroscopy may be similarly effective for pain relief and other patient-reported outcomes in a younger, more active population with a lower body mass index than previously studied. The results indicate that clinicians and middle-aged patients with meniscal tear and no definitive radiographic evidence of osteoarthritis should consider exercise therapy as a viable treatment option.
Read more: Exercise therapy versus arthroscopic partial meniscectomy for meniscal tear in middle aged patients: randomized controlled trial with two year follow-up
Dec 12, 2016 | Insights
Slips and falls, as well as illnesses and injuries caused by cold stress, pose considerable risk to employee health. Take these precautions to safeguard the well-being of your workers and maximize operability this winter.
Depending on your location and climate, winter can take a toll on the health and safety of your workforce. In frosty Michigan, for instance, slips and falls represent one-third of all workers’ compensation claims during winter months. Additionally, studies have shown outdoor work in colder temperatures to increase the incidents of low back and neck pain.
Although the Occupational Safety and Health Administration (OSHA) does not have standards that cover work in cold environments specifically, it is the responsibility of employers to provide a safe working environment for all employees, free of recognized hazards that are likely to cause serious physical harm. Here are some tips for carrying out this responsibility – and supporting your employees’ well-being – when winter arrives.
Minimize and alleviate cold working conditions
The best way to prevent cold-related illness and injury is to reduce the amount of time workers spend outside. You can do this by arranging for routine outdoor tasks, such as maintenance and repair jobs, to be handled in warmer months. During winter, minimize exposure to the cold by scheduling outdoor work for the warmest part of the day and limiting the amount of time spent outdoors on extremely cold days. If a long, demanding job can’t be moved to a warmer day, consider adding relief workers to the rotation for shorter shifts. Supply blast heaters where needed, and shield work areas from drafts or wind to reduce wind chill. Be sure to encourage workers to take breaks indoors and to consume warm beverages throughout the day.
Plan for hazards
Ice and snow buildup poses serious risk of slips and falls if not tended to properly. Have a maintenance plan in place 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 to prevent slippery conditions. If your workforce includes employees who routinely work outside, consider adding a mud room or entry room for workers to remove and store boots and outerwear to minimize tracking into other work areas.
Foolproof your communications
When winter conditions come on suddenly, employee communications can be critical, even life-saving. Have a system in place for monitoring weather conditions and staying attuned to public announcements related to severe weather. If operations must be suspended, be sure your communication methods allow you to reach all workers, including those in remote areas.
Assess your equipment
Routine tools and equipment may need to be rethought when being used in colder temperatures. It’s important to bear in mind that wearing bulkier clothing may restrict workers’ movement. Identify potential hazards so you can train your staff on appropriate safety measures. Have safeguards in place on machinery to prevent clothing from catching on handles, switches or levers.
Provide employee training
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. 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. Direct employees to dress appropriately, by layering loose fitting clothing. Train your workers to recognize the signs of cold stress and how to help those who are affected. Finally, 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, in cubicles or on a factory floor, winter requires planning and vigilance. Protecting your workforce and minimizing illness and injury by taking the steps outlined above will help keep operations smoothly – and safely – all winter long.
Sep 8, 2016 | Insights
Successful recovery from a musculoskeletal injury is reliant upon accurate diagnosis and appropriate treatment; however, these two areas of expertise are typically handled in two separate camps: radiology and physical medicine. Could patients benefit from bridging the gap between these two disciplines? MedRisk advisory board member Matthew Walsworth, MD, PT, weighs in.
The most recent addition to MedRisk’s International Scientific Advisory Board is a rare breed in the world of musculoskeletal medicine. Dr. Matthew Walsworth obtained a master’s degree in physical therapy from Baylor and went on to serve for 6 years as a physical therapist in the U.S. Army. He spent his days treating back and neck injuries, but, according to Walsworth, his role encompassed more than that.
“In the military, physical therapists are given a bit more autonomy as a point of direct care,” said Walsworth, referencing the enduring legislative and payer-imposed restrictions on PT as a direct point of access.
When Walsworth chose to leave the army and resume his life as a civilian, he decided to pursue a degree in medicine, in order to continue that direct care function. He had a hunch that his studies would lead him to a career in radiology, and he was right – although the realities of the position were at odds with his previous clinical experience.
“I enjoyed the diagnostic part of the job but soon realized that imaging often meant sitting in a dark room a good portion of the day. I missed that close interaction with patients,” Walsworth said.
This realization led Walsworth to pursue a fellowship in interventional radiology at UCLA, and, today, he splits his time between diagnosis and treatment as an interventional and diagnostic radiologist at the West Los Angeles Veterans Affairs Medical Center.
When asked how his physical therapy background informs his radiology practice, Walsworth says it’s all about perspective.
“I am able to look at things a bit more functionally,” he said. “The imaging and the function don’t always correlate. I treat a lot of patients with peripheral artery disease who suffer from pain in their legs due to poor blood flow. I can make confident decisions about when to choose lifestyle modifications and when to opt for a given treatment because I have seen the results of both first hand.”
Walworth’s multidisciplinary approach embodies the goal of MedRisk’s international scientific advisory board. Made up of an elite panel of world-renowned specialists in physical medicine and electrodiagnostics, ISAB is charged with maintaining evidence-based clinical guidelines for all of MedRisk programs – and filling the gaps between diagnostic imaging and physical medicine with proactive oversight and innovative integrated solutions.
As for physical medicine at large, what does the future have in store?
“I’m hopeful,” says Walsworth. “As physical therapy grows as a field, there may be opportunity for PTs to become more autonomous, and for PTs and radiologists to collaborate and communicate more. Integration would be hugely beneficial to not only us as clinicians, but also to our patients.”
Aug 4, 2016 | Insights
Workers in the manufacturing industry have the highest incidence rate of Carpal Tunnel Syndrome (CTS) out of any other industry, racking up 1.9 injuries per every 10,000 workers.
CTS is a significant contributor to higher-than-average physical therapy costs for 35- to 44-year-old workers in manufacturing driven mostly by parts assembly workers. As one of the most common injuries requiring physical therapy for this age group, CTS is third only to shoulder pain and lumbago injuries and affects twice as many female manufacturing employees as male.
However, new research from Spain suggests physical therapy may be just as effective as surgery in alleviating pain and restoring function. This research is leading those in the industry to posit a higher reliance on non-surgical physical therapy, which may equate to a decrease in surgical costs.
Read more: 2016 Trends Report: Manufacturing
