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.
