By Mary O’Donoghue, RN, Chief Operating Officer, MedRisk
COVID-19 forced many workers’ compensation surgeries and post-surgical physical therapy to be put on hold. As services resume, what should the industry expect to see in physical medicine?
In March, the American College of Surgeons (ACS) issued recommendations1 for managing elective surgical procedures to preserve U.S. health care resources for the anticipated surge of COVID-19 cases. Hospitals geared up for COVID-19 patients and emptied their surgical floors. Providers and patients postponed non-emergency surgeries and other procedures.
A new Postponement of Elective Surgeries and its Impact on PT study2 estimates that 343,670 U.S. operations were cancelled every week during a 12-week period of peak disruptions. It also estimated that more than 244,000 orthopedic surgeries were cancelled weekly in North America.
The number of unique patients seeking care in a hospital setting fell 54.5 percent across all service lines, according to a Strata Decision Technology analysis3. Authors suggested the decline resulted from cancellation of elective surgeries along with concerns about patient and staff safety during the pandemic.
Obviously, post-surgical PT planned for these cases did not happen.
Other patients cancelled post-operative and other physical therapy sessions because of virus concerns. And, many new post-surgical patients delayed the start of their care. MedRisk saw a 47.6 percent decline in post-surgical PT referrals when comparing data from April 2019 against April 2020.
While telerehab provided continuity of care for patients who met clinical criteria and were willing to try it, some much-needed physical therapy just did not happen.
Studies show that early physical therapy4 produces the best outcomes, reduces downstream medical costs and accelerates recovery.
It stands to reason, then, that delaying or interrupting care can lead to longer claim durations and slower recoveries along with their associated costs.
What can the industry expect now?
In late April, over 30 states gave the go-ahead to hospitals and surgical centers to resume routine surgeries. A “Health Care Credit Beat Growing Health Care Ratings Contagion from COVID-19” article5 published by spglobal.com suggests that “surgical volumes will return relatively quickly because certain procedures, such as cardiology and oncology, cannot be delayed too long.”
The postponement of elective surgery researchers predict that if the countries increased their normal surgical volume by 20 percent after the pandemic, it would take a median 45 weeks to clear the backlog of operations. Whether or not the U.S. healthcare system increases surgical volume, the workers’ compensation community faces nearly a year or more of managing postponed procedures.
Also, since providers will likely prioritize surgeries, non-urgent procedures, such as carpal tunnel, non-traumatic full-thickness rotator cuff tears and partial tears and meniscal (knee) tears, will be further postponed.
Impact on Patients
Delayed surgical patients have been waiting for operations during an unprecedented time of stress and uncertainty. Not knowing when they will have their operations while dealing with the uncertainty of how the coronavirus is contracted, spread, and treated, and a sudden economic downturn has added to their anxiety.
Many of have been in pain for months and taking opioids or other pain medications. In the worse-case scenarios, the delay resulted in irreversible damage to muscles, nerves, and other tissues.
Injured workers have had more time to worry and dwell on the perceived injustice of it all.
These patients are apt to feel a loss of control and experience other psychosocial issues. Anger, depression, and fear are likely exacerbated. Any patient compliance built up before the surgery was cancelled may be lost. To quote the postponement of elective surgeries researchers, “There is a risk that delayed treatment of benign conditions will reduce patients ability to work.”
Additionally, during stay-at-home orders, some patients have experienced deconditioning and are not prepared for surgery. Therefore, claims representatives will receive prescriptions for preoperative conditioning. High-quality evidence6 indicates that preoperative exercise reduces the need for postoperative services after total hip or knee replacement joint replacement surgery.
Many delayed-surgical patients will need a higher level of patient education, care management and possibly more physical therapy sessions than newly injured patients. A consultation with a PT prior to the start of physical rehabilitation or pre-surgical conditioning can help chart the best course of care while also identifying any psychosocial barriers to recovery and suggesting interventions, such as behavioral therapy or nurse case management.
On a positive note, some conditions that were once considered to be immediate surgical indicators now have evidence that supports physical therapy as an alternative. They may not need the surgery at all now.
Evidence-based medicine indicates physical therapy should be tried before surgery in several conditions. These diagnoses include non-traumatic, full-thickness rotator cuff tears or partial tears, degenerative meniscal tears in the knee, lumbar spinal stenosis, and lumbar herniated disk with stable neurological status. This is a good time to review claims and see if any patients awaiting an operation can be treated conservatively.
Physical medicine may also be deployed to condition workers in high-physical demand jobs who have lost strength and physical capabilities during a long stretch of inactivity. Conditioning programs should be tailored to specific job demands so the workers regain the strength and function needed to perform tasks safely and avoid injuries.
Injured workers who were hospitalized after being infected with COVID-19, especially those in intensive care units, can be expected to need some physical therapy for post-intensive care syndrome. In next week’s Leaders Speak, MedRisk’s Brian Peers will discuss this condition, which can cause patients to have difficulty with walking, balance, self-care, and other issues.
Claims professionals need to consider the delay-of-care impacts when setting reserves and planning return to work. Indemnity, overall medical costs, and attorney involvement could be higher than usual. Pre-operative physical therapy will be more prevalent, and the volume of post-operative physical therapy will be higher as surgical backlogs are cleared.
Physical therapy that was disrupted during the pandemic may take longer than normal to complete once patients return to clinics or start telerehab. Some physical therapy clinics closed during COVID-19, and some may not be able to reopen7, impacting patient access and network coverage.
All these factors make it essential to partner with a specialized managed care organization that goes beyond scheduling and basic visit management. Evidence-based guidelines and pre-therapy consultations with a physical therapist inform effective treatment plans and detect psychosocial barriers to compliance and recovery. A financially sound partner with a strong, patient-centric program and robust clinical foundation that supports clinically based decision making for payers will be critical in the coming months and years.
About Mary O’Donoghue
Mary O’Donoghue oversees MedRisk’s clinical, administrative and operational functions. Her responsibilities encompass clinical management, product development, provider relations and network oversight along with patient advocacy and customer service. O’Donoghue also guides the efforts of MedRisk’s International Scientific Advisory Board (ISAB), including the development and updates of evidence-based guidelines.
A Registered Nurse by trade, she joined MedRisk in 2016 as Chief Clinical and Product Officer and led the development of MedRisk’s Telerehab program, its On-Site PT offering and PTConsult services.
Previously, O’Donoghue held senior leadership positions in strategic planning, operations management, and product development with top carriers, third party administrators, and managed care organizations in the group health, disability, and workers’ compensation industries. She can be reached at email@example.com.
Based in King of Prussia, Pennsylvania, MedRisk is the largest managed care organization dedicated to the physical rehabilitation of injured workers. One of the Inc. 5,000 fastest growing privately held companies for 13 consecutive years, MedRisk counts over 272,000 providers in its network and serves almost 550,000 injured workers every year.
It holds direct contracts with more than 90 percent of the nation’s top workers’ compensation insurers and third-party administrators.
MedRisk, which has successfully completed a SSAE 18 SOC Type 1 and 2 examination, ensures high quality care and delivers outstanding customer service. To that end, all customer service professionals, healthcare advocates and physical therapists are based in the U.S. For more information, visit www.medrisknet.com or call 800-225-9675.
MedRisk is a WorkCompWire ad partner.
This is NOT a paid placement.