May 30, 2019 | Insights
Can physical therapy optimize recovery following knee replacement surgery? A recent study of TKA patients offers new insights.
According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States. In fact, total knee arthroplasty (TKA) is the most commonly performed inpatient surgical procedure in the United States.
However, some studies have indicated that rehabilitation following knee replacement surgery may not be needed to optimize recovery. Setting out to examine this hypothesis, a team of researchers from the University of Colorado School of Medicine recently conducted a study with the objectives of (1) investigating whether PT utilization is associated with functional improvements for total knee arthroplasty (TKA) patients in home-health-care settings and (2) exploring which factors are related to PT utilization.
The 2018 study, which was published in The Journal of Bone and Joint Surgery, analyzes Medicare home-health-care claims from 2012 for TKA patients who received home-health-care services following surgery. In comparison to low home-health-care utilization, which was defined as ≤5 visits, utilization of 6 to 9 visits was associated with 25% greater improvement in activities of daily living (ADLs) over the home-health-care episode, and improvement increased from there, with 10 to 13 visits seeing 40% greater improvement and ≥14 visits being associated with 50% greater improvement. In addition, patients receiving home-health-care from rural agencies were observed to have lower PT utilization (10.7% fewer visits).
After controlling for medical complexity, baseline function, and home-health-care episode duration, low PT utilization was significantly associated with worse ADL recovery for study patients. Researchers also found that that low users of at-home physical therapy often had less social support and more complex medical conditions and that without adequate post-op care, these patients could require future hospitalization or institutionalization. The bottom line? According to lead researcher Dr. Jason Falvey, the risks of not providing the appropriate level of care post-surgery may result in higher overall healthcare costs in the long term.
More research is needed to develop specific evidence-based treatment strategies for TKA patients, but based on these findings, telerehab, which allows post-surgery treatment to be done in the home, may be a useful tool in promoting patient engagement and utilization for better outcomes after surgery.
Click here to read the article.
Falvey, J. R., Bade, M. J., Forster, J. E., Burke, R. E., Jennings, J. M., Nuccio, E., & Stevens-Lapsley, J. E. (2018). Home-Health-Care Physical Therapy Improves Early Functional Recovery of Medicare Beneficiaries After Total Knee Arthroplasty. JBJS, 100(20), 1728-1734.
Feb 25, 2019 | Insights
Occupational injury rates and workers’ comp claim frequency continue to decline. Is your total spend for musculoskeletal treatment following suit?
In this two-part series, “Workers’ Comp Costs: Why Physical Therapy is Bigger than You Think,” we explore some of the reasons why, despite positive overall claim trends, the percentage of claims with physical therapy (PT) involvement is on the rise – and why a managed physical medicine program continues to be a necessary component of workers’ comp managed care.
As discussed in part 1 of this series, on-the-job injury rates are declining, but physical medicine claims are steadily climbing, with outpatient physical therapy services listed on 63% of 2017 lost time claims.
Why is physical medicine a part of so many workers’ comp claims? To better understand this trend, let’s take a step back and look at how musculoskeletal injuries affect today’s employees and employers.
The Prevalence of Work-Related Musculoskeletal Injury
According to the Bureau of Labor Statistics (BLS), musculoskeletal disorders alone, including injuries resulting from overexertion such as sprains and strains, made up 31 percent of the total cases for all workers in 2015. While claims rates are falling due in large part to workplace safety programs, the numbers show that accidents are still a risk. And if you’re a growing company with a growing number of employees, that often means assuming higher risk. Falls, slips, and trips accounted for 27 percent of the total occupational injuries and illnesses, and the incidence rate of workers being struck by an object or equipment increased year over year. Professions at a high risk include laborers and freight, stock and material movers; nursing assistants; and heavy and tractor-trailer truck drivers – each accounting for almost 5 percent of the private sector’s musculoskeletal cases in 2015.
Extended Lost Time
The prevalence of musculoskeletal injuries becomes even more concerning when you consider that musculoskeletal disorder cases typically have more days away from work than the average nonfatal workplace injury or illness. In fact, according to BLS data, in 2017, the median number of days away from work for musculoskeletal injuries was 13 compared with 9 for all other workplace injuries. Unless well-coordinated, recuperation for patients with musculoskeletal injuries can be unnecessarily complicated and drawn out. One way to counteract these effects is for employers to ensure injured workers are matched with the right physical therapist as quickly as possible and feel supported during the scheduling process so treatment can begin promptly. Physical therapy as a first-line of treatment has been shown to be a cost-effective contributor to positive patient outcomes.
Conclusion
Workplace safety programs are a big part of keeping workers’ comp claims in check, but for the injuries that cannot be prevented, employers must set their workers up for success. A managed physical medicine program is a must-have for employers as the increase in claims with physical medicine involvement continues to climb. Ensure your company has the necessary partners and resources in place so that no matter how much your company grows or healthcare policies change, your injured workers can rely on a supported and streamlined road to recovery.
Feb 1, 2019 | Insights
Occupational injury rates and workers’ comp claim frequency continue to decline. Is your total spend for musculoskeletal treatment following suit?
In this two-part series, “Workers’ Comp Costs: Why Physical Therapy is Bigger than You Think,” we explore some of the reasons why, despite positive overall claim trends, the percentage of claims with physical therapy (PT) involvement is on the rise – and why a managed physical medicine program continues to be a necessary component of workers’ comp managed care.
For almost a decade the news of fewer occupational injury rates and the declining frequency of workers’ compensation claims have been making headlines. Experts credit the downward trend to a wide range of contributing factors, including advances in safety, automation, better management and more.
However, some employers may be surprised that their workers’ comp costs, especially those related to musculoskeletal treatment, are not necessarily mimicking this descending slope.
While injury rates and frequency have been declining, data from the Workers’ Compensation Research Institute (WCRI) show that the percent of claims with physical medicine involvement has been increasing. In 2011, 56 percent of lost time claims included outpatient physical medicine services (i.e., physical therapy, occupational therapy or chiropractic care). By 2017, the 18-state median was up to 63 percent with some states like California and New Jersey even higher at 72 and 71 percent, respectively.
This consistent, year-over-year increase can be attributed in part to a better understanding of the value physical medicine brings to the workers’ compensation community and the benefit it plays in supporting return to work goals. Physical medicine not only helps address musculoskeletal issues; it also promotes patient participation in recovery and self-management, improves patient compliance with treatment strategies and reduces the risk of re-injury.
Today, mounting evidence shows that early physical therapy also reduces the risk of opioid addiction and can reduce downstream healthcare costs, suggesting that this trend of increased PT involvement will continue and even escalate. With multiple visits to coordinate, continued authorization requests to manage and a variety of return-to-work treatment strategies to implement, employers must ensure they are equipped to effectively manage physical medicine today and in years to come.
Click here to learn more about one managed care program and the trends impacting physical medicine in workers’ compensation.
And stay tuned for part 2 of this series, where we’ll look more closely at the nature and effect of musculoskeletal injuries in the workplace – and physical medicine’s role in getting workers back on their feet.
Feb 1, 2019 | Insights
The opioid crisis
has been declared a national Public Health Emergency. Can physical therapy help
curb opioid use among musculoskeletal patients?
A December 2018 study published in JAMA Network Open caps off a growing body of research demonstrating early physical therapy’s association with reduced opioid use. The study, which looked at data from 88,985 privately insured patients who visited their provider with back, knee, neck or shoulder pain, found that those who received physical therapy treatment within 3 months were less likely to take opioids for their condition.
Researchers tracked opioid prescription and use data over the
course of one year among the two patient groups: those who had PT within 90
days of the index visit and those who didn’t. Researchers found that early PT
was associated with a reduced risk of opioid use for all conditions: knee pain
(-16%), shoulder pain (-15%), neck pain (-8%) drop and low back pain (-7%).
Among patients who were prescribed and used opioids, an association between
early PT and a reduction in pills was noted for all conditions except the neck
pain subgroup. Notably, patients who received early PT had a significant
reduction in the likelihood of chronic opioid use in two subgroups: 66% for
knee pain and 33% of low back pain.
The time to PT treatment varied among participants by condition,
ranging from an average of 13 days after index visit for neck pain to 40 days
for shoulder pain. The positive outcomes of this study drive home the
importance of early physical therapy treatment. MedRisk’s managed physical medicine program matches injured workers with the right
physical therapist as quickly as possible – with an average of 4 hours to
scheduling and 2.6 days to initial treatment.
Click here to read the article.
Sun, E., Moshfegh, J., Rishel, C. A.,
Cook, C. E., Goode, A. P., & George, S. Z. (2018). Association of Early
Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With
Musculoskeletal Pain. JAMA network open, 1(8), e185909-e185909.
Nov 28, 2018 | Insights
Most practices are familiar with Medicare’s “8 Minute Rule” for billing time-based CPT codes. While Medicare historically required compliance with the rule, most workers’ compensation regulations did not address it. Until now.
Twelve states have begun strictly enforcing the billing rules related to the use of timecodes in workers’ compensation, prompting insurance carriers, TPAs and self-insured employers to take a closer look at provider compliance with the rule. These states are Alabama, Indiana, Kentucky, Maine, Michigan, Minnesota, Montana, North Dakota, Pennsylvania, South Dakota, and Texas. MedRisk encourages its network providers to follow the billing rules in these states when billing timed codes.
While regulations in Alaska, Arizona, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Kansas, Maryland, Nebraska, North Carolina, Ohio, South Carolina, Tennessee, Virginia and Washington are more ambiguous, payers may eventually be taking a closer look in these states as well.
MedRisk is here to help our network providers comply with all pertinent legislation and regulation and hopefully, this information will give you a good start.
There are various methods used to apply the 8 minute rule and each state has guidelines on which method to use. To avoid unnecessary denials, make sure that all billing for timed codes follows the appropriate rules in your state and is supported by the clinical notes and/or flow sheet. If the billing units for timed CPT codes don’t match the treatment described in the supporting material, your bills will likely be denied and returned. Also, remember that your billing for timed codes cannot include time spent treating for untimed codes.
If you have any questions about this or anything else, please contact MedRisk’s Provider Relations Department at 866-697-3707 or providerrelations@medrisknet.com
