By: Nancy Rothenberg, Vice President, PTPN
Due to the prevalence of work-related musculoskeletal injuries, specifically lower back claims, physical therapy (PT) often plays a key role in workers’ compensation programs. A key, but not always a strategic role. Too often, PT is viewed as a commodity and the focus is on simply ensuring a carrier or employer contracts with the largest and/or lowest cost provider network.
After nearly 30 years in this industry, I can attest that is not the way to secure optimal outcomes, overall lowest costs, or even satisfaction from an injured worker. What does work is a much greater focus on the quality of PT providers in a network, their proven ability to improve outcomes, the commitment of those physical therapists to your goals, and an organization’s willingness to explore and consider new payment models and options. In short, to incorporating PT as an overall strategy for your work comp programs.
So how does an organization get there? Here are five steps to consider:
1. Recognize the value of PT in reducing medical and indemnity costs. Here is perhaps the primary value proposition for PT: it helps lower indemnity costs, which are often the most significant part of the workers’ comp spend, as well as medical costs. A look at two patients receiving care for similar injuries is revealing: One is promptly referred to a physical therapist and the other is not, and instead receives physician care, imaging, and a surgical consult, all while also on opioids and only after several weeks of going to PT. In this example, on average, the patient receiving prompt PT has $2,400 less in medical costs. But here’s an even bigger reality of that common approach to a work comp injury: The disability costs over a three month period are $10,000 more than the worker who received prompt PT care.
2. Know who’s providing your physical therapy. Physical therapists today are primarily in independent, group, hospital-affiliated or physician-owned practice. Full disclosure here, I manage the nation’s first network of independent physical therapists. However, research supports my belief that it offers the optimal model for workers’ comp payers. For example, a 2014 study (PDF) by the Government Accounting Office (GAO) found that in the year a provider began to self-refer to their own physical therapists, those referrals increased more than twice as much as independent physical therapists.
3. Do something about opioid utilization. Industry publications and conferences are full of information about the dangers of excessive opioid use. While we are starting to see downward trends, there’s a lot more to be done. One challenge is that on paper, opioids seem to be a faster and a lower cost way to help minimize pain. But that’s just part of the story. A study of 12,000 workers’ comp claims found that those involving certain types of opioids were almost four times as likely to have an overall cost of $100,000 or more than were claims without a prescription. These workers often had delays in RTW and, more importantly, the use of medications didn’t target the underlying problem or help the worker return to job functionality, or address the issue of re-injury. Those are the issues workers’ comp payers need to consider. Instead, bring in PT early to help eliminate or reduce reliance on opioids, get workers back on the job more quickly and reduce your overall medical and indemnity spend.
4. Emphasize appropriate utilization. One standard approach used to manage physical therapy is mandating a specific number of visits that a general diagnostic category should require. However, the reality is that some patients may take more time, some less. A 63-year-old man with a knee injury is different than a 34-year-old woman with a similar injury. Look for providers who take a patient-specific, data-centered approach and provide you with reporting to support treatment plans.
5. Look for therapists who are experienced with and understand today’s innovative payment models. While payment models in group health programs tend to offer more options, that doesn’t mean that payers on the workers’ comp side shouldn’t explore new payment alternatives. Performance-focused models like pay for outcomes (P4O) have applications and value in workers’ comp. The key is physical therapists who understand how these models work and who have the track record to show they offer the quality to produce the outcomes to make these programs work. Look for more on those options, and why a focus on cost alone when building networks is counter-productive, in next week’s article.
The workers’ compensation industry has made significant strides in the past few years toward building better and more outcome-focused programs. PT programs with the right network of physical therapists are essential to leveraging efficient care, reducing indemnity costs, and returning injured workers to functionality and their jobs. By incorporating PT as a strategy, not a commodity, and collaborating with independent physical therapists who are committed to your vision, you can achieve the goals you want and need in your work comp program.
About Nancy Rothenberg
Nancy Rothenberg has played a key role in the development of PTPN for almost 30 years. In this role, she is responsible for overseeing the day-to-day operations of the company, including payer and provider contracting, marketing and sales, provider relations, systems, data processing, political action, and planning, budgeting and analysis of overall network performance.
Rothenberg has authored a number of articles on contract management and physical therapy and has been published in such journals as Workspan, ADVANCE for Directors in Rehabilitation, Risk Management, The PPO Letter, and the Journal of Health Care Benefits.
PTPN is the nation’s premier specialty network of rehabilitation therapists in independent practice. It has led the rehabilitation industry since 1985, pioneering innovative payer contracting, quality assurance, outcomes measurement, and pay-for-outcomes (P4O) programs. The network comprises hundreds of therapy office locations and thousands of physical, occupational, and speech therapists across the country. PTPN contracts with most major managed care organizations in the nation including insurers, workers’ compensation companies, PPOs, HMOs, medical groups, and IPAs. All members of PTPN must be independent practitioners who own their own practices. For more information visit ptpn.com.