During our time at NWCDC 2014, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “3 For NWCDC” series, focused on this year’s developments and on improving the system! Here’s what Michelle Despres, PT, CEAS II, Align Networks’ Executive Director, National Product Leader had to say:
1. Looking back on 2014, what do you believe was the most significant development for the Workers’ Comp industry?
With a quarter to one third of workers’ compensation claims requiring Physical Therapy (PT) services, the industry is challenged to ensure an appropriate level of utilization on each and every case. The most common outpatient PT prescription in regards to frequency and duration is three PT visits a week for four weeks across a majority of diagnoses. The industry needs stringent controls, applied at multiple points across the claim’s life cycle to ensure claimants receive the right care at the right time. In this way, payers can be assured that each claim is reviewed on an individual basis, so neither over-utilization nor under-utilization occurs. For example, if an injured worker does not need to continue PT and demonstrates the ability to perform the necessary job-related functional tasks, indicating potentially a readiness to return to work (RTW), a quality PT provider can help point out this fact. In other situations, we work with our PT providers to advocate claimants continuing PT due to various medical needs. For example, perhaps an injured worker is progressing but due to their advanced age, the progress is slower than anticipated.
2. If you could wave your magic wand, and instantly change one thing about 1) Workers’ Comp and 2) your business, what would you change?
I have previously worked as a PT, so if I could wave a magic wand, I would ensure that every injured worker who requires PT services is matched to a quality provider that is an expert in rehabilitation of this population. Oftentimes, when a worker sustains an injury, they may experience pain, discomfort, and anxiety. A quality PT can help the injured worker maintain a positive mindset through their therapy and recovery—by setting RTW goals, tracking progress along the continuum of care, and sending progress summaries to their treating physicians. PT excellence starts with directing claimants to a quality PT provider, and then incentivizing those providers to appropriately manage utilization through a rigorous, outcomes based provider scoring system. In this way, Align has been able to actively steer more referrals to the providers who achieve optimal outcomes in regards to RTW and cost savings.
3. What is one thing you’d like to promote?
One thing the industry might not realize is Align has established a comprehensive Gold Standard clinical oversight program to ensure best possible outcomes, improved RTW and stay at work (SAW) results, and significant savings for customers. As part of this program, we have a team of more than 65 licensed PTs, OTs, CHTs, and chiropractors who perform peer-to-peer review of cases to ensure quality and adherence to evidence-based clinical guidelines, such as ODG, while considering every case based on individual circumstances. We support a transparent process, in which our team handles on average more than 1500 communications a day with PT providers, treating physicians, claims examiners, and nurse case managers, keeping all these stakeholders on the same page about the injured worker’s PT progress.
About Michelle Despres
Michelle Despres, PT, CEAS II, is the executive director at Align Networks, a leader in physical medicine for workers’ compensation. In her role, Michelle serves as a clinical liaison among payers, providers, and Align’s internal teams, helping to strategize on how to continually improve return-to-work results. She helps clients understand how Align can fulfill all of their physical medicine needs with clinical excellence and care coordination efficiency. Having worked as a PT, Michelle also provides customers with a clinical perspective on their PT claims performance, and delivers CEU training to their claims staff on many PT, ergonomics, and rehabilitation topics.