June 20, 2018

Physical Therapy in Workers’ Comp – Are You Considering These Cost Drivers?

Lower back pain (LBP) due to injury remains one of the most common and costly conditions in workers’ compensation claims, and the majority of costs are associated with a fraction of the population. Ten to 15 percent of LBP patients drive approximately 75 percent of associated medical costs and lost productivity.1 This indicates that there is still considerable opportunity for more effective strategies in managing LBP treatment, including physical therapy services.

Healthesystems Aug15 PP Physical Therapy

While curbing overutilization is an important part of cost containment, there are other factors that impact successful outcomes in injured workers – and ultimately, incur additional costs for payers. A physical medicine program that is able to address all of these factors provides a new level of effectiveness, one that goes beyond basic utilization management. This enhanced model is now able to manage the full spectrum of care and potential cost drivers.

Factors impacting successful outcomes in injured workers:

  • Physician: Treatment decisions that don’t follow evidence-based medicine (e.g., prescribing opioids or advanced imaging when PT is recommended)
  • Patient: The injured worker elects to stop therapy (patient nonadherence)
  • Treatment Provider: Ineffective or low-quality physical therapy services (which in turn can drive overutilization or patient nonadherence)

To more comprehensively address these challenges, a physical medicine program must evolve from the traditional quantity-driven mindset and embrace a strategy that emphasizes quality of treatment measured by objective, clinical outcomes.

Average applies to a population, not a patient. LBP is a highly heterogeneous condition, and treatment needs vary from patient to patient. It’s time to throw away the concept that management of physical therapy services can be based on a number. Quality of care and measures of functional improvement should guide authorization.

Overutilization isn’t the only challenge in managing physical therapy costs. A significant portion of payer spend is also wasted on:

  • Poor long-term outcomes
  • Ineffective therapy
  • Patient nonadherence
  • Avoidable procedures/surgeries
  • Excessive/unnecessary services (e.g., imaging)
  • Prescription medications

Cost containment is an outcome, not a strategy. Evidence-based application of physical therapy results in decreased LBP-related utilization of physical therapy visits, imaging services, injections and surgery, as well as reductions in overall LBP-associated costs.2,3

Healthesystems’ physical medicine solution was shaped by evidence demonstrating that guidelines-based application of care leads to better clinical and financial outcomes.

To read more about opportunities for containing physical therapy costs in the injured worker, and the benefits of our enhanced approach, visit: www.healthesystems.com/physicalmedicine.

1Wertli MM, Rasmussen-Barr E, Held U, et al. Fear-avoidance beliefs – a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14:2658-78.
2Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res. 2014;49:645-65.
3Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15:150.

Partner Post:
This is a sponsored post from WorkCompWire marketing partner Healthesystems.

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