By Joseph R. Noel, PT, VP Clinical Services, TechHealth
Much has been said recently about the introduction of Medical Treatment Guidelines into the workers’ compensation paradigm. Given their value, that chatter will only increase and the volume around them as well. Good. This needs to happen. The system is, in some ways, very broken and in need of repair. The benefits of introducing objectively based Guideline Management tools can only bring clarity in otherwise cloudy waters. The Physical Medicine domain is the perfect area to focus on as the current choices for providers exemplify just the very problems that need to be fixed.
With all that chatter out there, I am left wondering one question. If the guidelines exist and the collective consensus is they will improve outcomes for patients and the (claims handling parties), why isn’t anyone following them? The answer seems to lie somewhere between “we have always done it this way” and “that just isn’t fair”. I offer a different answer- there is no imminent need to change because too few are truly trying to manage these patients the right way. Ask yourself whether a sprain occurring at home differs from a sprain suffered at work and should these same injuries progress and heal differently and you very quickly arrive at the “right” answer. Better yet, ask the guideline management tools the same question and then look at the data behind clinical interventions for the injured worker vs. the weekend warrior. The increased costs and differing treatment paradigms demonstrate the problems that exist in the workers comp arena.
Healthcare practitioners including Physicians, Physical and Occupational therapists and others are licensed and trained to evaluate injuries of all kinds. While some are specialists in “Occupational Medicine”, the need to be so is not as pertinent as one may think. While we healthcare practitioners certainly give credence to the patients job requirements, we evaluate the injury for what it is- a strained lower back or a torn rotator cuff. We establish a baseline of the patients’ functional deficits and then create a plan to restore their function. This may require multiple service lines and time to be complete but these steps taken (or followed) are no different based on the origin of the injury. The goals remain the same and the time to deliver the best clinical outcome should too.
We all know this. This isn’t new or necessarily newsworthy. None of us need to be made aware of the existence of the guidelines but rather we should be made aware of who is using them. It isn’t enough to simply talk about their existence. To bring about change and to produce better clinical outcomes the industry needs to demand a better performance of not only the healthcare practitioner but also the administrative persons and Networks managing the claims.
Managing an injured workers’ needs should be an objective process. By evaluating the patients’ response to the prescribed therapies and medications and referencing those results against the widely accepted and objective guideline tools, we get a better understanding of what is working or what needs to change to drive a better outcome. While this may seem new and potentially newsworthy, it isn’t. Clinicians have been managing patients’ needs for years according to guidelines and within well defined parameters for commercial and government payers, but they have never had to do so for the injured worker. And they have never been held accountable for delivering progress. The time for action determined through objective decision making is now. The time to discuss the notion of the benefits for guideline tools is long since past.
The landscape in Physical Medicine in 2013 can be broken down into the 3 distinct strategies that define the major players. One approach has the PT Network establish different relationships between customer and provider. This inherent disconnect between all parties leads to inevitable clashes as customer and provider expectations differ and each cannot be fairly met. Another approach is the “business as usual” model that has been a mainstay in the industry for decades. This servicing of requests via rubber-stamping is the root of the problem as I see it. The need for rehabilitation following injury has been well documented. So too have the abuses in therapy via overutilization. The two aforementioned strategies purport to address guideline management recommendations. They do not. Simply mentioning them falls short of applying them. It simply adds to the chatter.
An objective tool to help drive better decision making does exist and is currently in use as you read this. One company has recognized the need to deliver better outcomes and by merging technology with clinical guidelines and is doing so. This is newsworthy. This is different. This is what has been needed for quite some time. This patent pending process separates one company from the rest and is now the topic of discussion rather than just plain chatter. Managing Physical Medicine cases can now be done with improved efficiencies with objective tools guiding decision making leading to better clinical outcomes.
It’s 2013 and the time to apply what we know is now. Enough talk. It’s time to deliver.
TechHealth is a WorkCompWire Advertising Partner.
This is not a paid placement.