By Tate Rice, PT, DPT, MBA, Director of Product Management (Clinical), Healthesystems
Did you know the average injured worker patient spends six to 12 hours with their physical therapist (PT) over one episode of care? That’s a lot of face time. During this time, PTs may serve as educators and motivators for injured workers.
Every October, the American Physical Therapy Association celebrates the importance of PTs during National Physical Therapy Month. Being a Doctor of Physical Therapy myself, I obviously want to take this opportunity to recognize the practice. I’ve had the privilege of leveraging my expertise in the field in a variety of roles – from treating therapist to VP of Clinical Operations – and now in my Product Manager role at Healthesystems, where PT is one overall component in the workers’ comp medical care ecosystem.
The theme for this year’s National Physical Therapy Month is “The Value of PT” and highlights the ways physical therapy improves quality of life. I can’t think of a more fitting theme, as PTs are such an important part of an injured worker’s recovery. Not only do they help heal physical injuries, they build relationships with injured workers that can also help them heal mentally.
PTs are in a unique position to observe the injured worker’s behavior and discuss how their recovery is going. This is important when you’re talking about workers’ compensation because an injured worker’s state of mind can have an impact on claim durations and costs. Even worse, it can negatively impact their recovery and make it more difficult for them to return to work.
The Mental Health Side of Injuries
As a practicing PT, I’ve seen firsthand that mental health can decline in the first six to 12 months following an injury, and studies confirm this. I know that a patient’s beliefs and perceptions regarding their injury can affect their treatment and recovery. This gives me as the PT the opportunity to have directed conversations with patients about their mental health.
The American Physical Therapy Association (PDF) confirms this role for PTs, stating “It is within the professional scope of the physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and populations.”
Identifying Signs Early
In my practice, I use several different screening tools to pinpoint the signs of behavioral or social factors that might impact recovery during initial evaluations, which are typically one hour. These tools are important because many symptoms, such as fatigue or insomnia, are common in both depression and many other medical conditions – maybe even more common than you think.
At Healthe we analyzed over 100,000 episodes of patient care, and more than 4 of 5 included at least one social or behavioral determinant of health. The good news is that these can be identified early with the right tools – with 1 in 3 being identified within the first 30 days of injury through data captured at the initial evaluation.
Some tools that PTs can use to capture these insights include:
- General Anxiety Disorder 7 (GAD-7), a self-reported questionnaire for screening and measuring the severity of generalized anxiety disorder.
- Patient Health Questionnaire 9 (PHQ-9), a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression.
- Patient-Reported Outcomes Measurement Information System (PROMIS), a National Institutes of Health-funded initiative that evaluates and monitors physical, mental, and social health.
- Orebro Musculoskeletal Pain Questionnaire (OMPQ), a screening tool that predicts the risk of long-term disability and failed return to work.
Depending on the results of these tools, I have often referred patients for behavioral services. But even when I didn’t, the information I documented during my one-on-one interactions with patients could be just as useful in helping payers identify at-risk patients. At Healthesystems, we’ve seen that each episode of PT care results in more than 50 pages of documentation, making PT notes a valuable source of insight.
The PT’s Role in Recovery
Beyond looking for mental health concerns, the PT is pivotal in helping patients recover. To heal an injury, we generally help patients exercise the affected, joint, muscle, or tissue. This helps them to reduce pain and regain range of motion and strength. Strengthening through the full range of the injured body part also reduces the likelihood of reinjury.
Just as identifying the signs of mental health concerns early is important, so is starting PT early. Not only does it hasten a patient’s physical recovery, but it can also counteract the mental toll that an injury takes. Inactivity is one of the reasons many injured worker patients begin to feel depressed; restoring that activity as quickly as possible may stave off the greater effects of depression.
Secondly, we’ve seen that injured workers who begin PT right away need fewer visits. In a Workers’ Compensation Research Institute study, patients who initiated PT more than 30 days after injury had worse health outcomes than those who began therapy within three days. Those who initiated PT later were 47% more likely to have an MRI, 46% more likely to be prescribed opioids, 29% more likely to receive injections for pain management, and 89% more likely to have back surgery. Those are a lot of negative consequences!
A Unique Opportunity
For injured workers, a full recovery often means healing both physically and mentally. Identifying patients with mental health concerns can take time that is in short supply across many of today’s healthcare settings. Fortunately, PTs spend considerable time with injured worker patients and are in the best position to work toward physical recovery while also identifying and mitigating any behavioral concerns that may surface.
About Tate Rice
Tate Rice, PT, DPT, MBA is a Director of Product Management at Healthesystems, where he leverages his strategic clinical and operational expertise to drive the development of innovative products, programs and services. In addition to his extensive clinical experience in the physical therapy space, Dr. Rice holds more than 17 years of experience in project management and business development within the healthcare industry, with proven capabilities in managing the critical aspects of project delivery, including operation management and business process redesign. His strategic vision and ability to develop and market services have enhanced patient care, access and value while sustaining growth in a changing healthcare marketplace. Dr. Rice earned his Doctor of Physical Therapy at Temple University and his Master of Business Administration at the Drexel University LeBow College of Business, both located in Philadelphia.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, physical medicine, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
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This is NOT a paid placement.