By Anthony Marcket, PT, Chief Operating Officer, ION PT Network
Physical therapy networks have played an important role in workers’ compensation for decades. They have expanded access to care, simplified the referral process, created greater geographic coverage and helped bring cost discipline and consistency to an important component of an injured worker’s recovery.
Those capabilities remain essential. But as our industry continues to evolve, I believe our thinking about physical therapy needs to evolve with it.
The question can no longer simply be: Can we get the injured worker into physical therapy?
We also need to ask: Once treatment begins, is the injured worker progressing, and is the care continuing to support the best possible recovery?
That distinction represents an important shift from thinking about physical therapy primarily as a network to thinking about how we clinically manage the entire episode of care.
Physical Therapy Is a Clinical Progression, Not a Transaction
As a physical therapist, one of the most important things I have learned is that no two recoveries are exactly alike.
A diagnosis and prescription provide a starting point, but they do not tell us everything about how an individual will progress through treatment. Two injured workers with similar diagnoses may have different functional limitations, job demands, comorbidities, recovery expectations and responses to therapy.
That is why physical therapy is best viewed as a clinical progression.
Throughout an episode of care, therapists are continually evaluating function, pain, mobility, strength, tolerance and progress toward specific goals. Treatment should evolve as the patient progresses.
In workers’ compensation, that progression has an additional dimension: helping the injured worker safely regain the function necessary to get back to their pre-injury levels and return to work without limitation.
The number of visits matters. The cost of those visits matters. But neither tells us whether the injured worker is actually getting better.
Access and Clinical Management Serve Different Purposes
A strong physical therapy network answers an important question:
Can the injured worker receive appropriate care quickly and conveniently?
Clinical management asks an additional set of questions:
- Was the Injured worker evaluated for the correct and compensable body part(s)?
- What happens after treatment begins?
- Is the injured worker progressing and are those gains objectively measured? Does the current course of care remain clinically appropriate?
- Are there signs that something may be preventing recovery?
These are not competing concepts.
Workers’ compensation needs both.
Access, geographic coverage, provider quality, negotiated rates and administrative efficiency are all important components of a successful PT program. But they represent the infrastructure through which care is delivered.
Clinical management adds visibility into the recovery occurring within that infrastructure.
What Should Clinical Management Mean?
The term “clinical management” can mean different things across healthcare. In physical therapy, I believe it should start with understanding the injured worker’s recovery journey and recognizing when that journey may require additional attention.
Several principles are important.
Clinical appropriateness. Treatment should align with the individual’s condition, functional limitations and recovery goals.
Progress. We should understand whether function is improving over time—not simply whether visits are occurring.
Utilization. Frequency and duration should make sense in the context of the individual’s clinical progression.
Continuity. Additional prescriptions or extensions of therapy should be considered within the context of the entire episode of care rather than as isolated events.
Clinical exceptions. When someone is not progressing as expected, we should recognize that early enough to begin asking why.
Recovery goals. Ultimately, treatment should be moving the injured worker toward greater function, independence and, when appropriate, return to work.
None of these principles are about applying the same treatment formula to every injured worker. In fact, effective clinical management requires exactly the opposite: understanding when an individual’s recovery warrants a different approach.
Clinical Management Should Not Mean Less Physical Therapy
This distinction is particularly important in workers’ compensation.
Managing physical therapy should not become synonymous with reducing physical therapy.
The objective should be appropriate care.
There will certainly be situations where clinical review raises questions about continued utilization without corresponding functional improvement. But there will also be cases where the issue is insufficient treatment, delayed access, lack of progression, psychosocial barriers, changing clinical circumstances or other factors interfering with recovery.
Sometimes the right answer may be fewer visits. Sometimes it may be additional treatment. And sometimes it may be recognizing that the current approach is not producing the expected result and asking what needs to change.
The goal should not be to minimize physical therapy.
The goal should be to maximize the value physical therapy contributes to recovery.
Claims Professionals Need Insight, Not Just More Data
Workers’ compensation claims professionals manage increasingly complex cases involving physicians, therapists, employers, injured workers and numerous other stakeholders.
We should not expect an adjuster to also become a physical therapy expert.
Technology has given our industry access to more information and data than ever before. But more of that alone does not necessarily lead to better decisions.
Knowing that an injured worker completed another six visits is data.
Understanding whether those six visits produced meaningful functional improvement is insight.
That distinction is critical.
The opportunity for our industry is to translate physical therapy information into meaningful clinical visibility. Is the injured worker progressing? Is the treatment trajectory reasonable? Has something changed? Is there a potential barrier to recovery? Does this case warrant closer attention?
Answering those questions can make clinical information more useful to everyone involved in the claim.
Are We Measuring the Right Things?
Workers’ compensation has traditionally measured physical therapy using metrics that are readily available: network penetration, discounts, cost per visit, visit counts and total spend.
Those measures remain important.
But are they enough?
I believe the next generation of PT measurement needs to connect a broader set of factors:
Access → Utilization → Functional Progress → Duration → Return to Function/Work → Total Episode Value
Our industry is not yet able to measure every element of that continuum perfectly or consistently. That should not prevent us from moving in that direction.
In fact, one of the most important opportunities ahead of us may be developing better ways to define, capture and communicate meaningful physical therapy outcomes.
If we measure only what care costs, we risk overlooking what that care accomplishes.
Moving From Managing Visits to Understanding Recovery
Workers’ compensation has made tremendous progress in building efficient physical therapy networks. The next evolution may be less about simply expanding those networks and more about gaining greater visibility into what happens after an injured worker enters them.
As both a physical therapist and an operations leader in workers’ compensation, I believe there is a significant opportunity to connect access, clinical insight and functional recovery more closely.
A network helps an injured worker get into care.
Clinical management helps us understand what happens next.
And ultimately, the most important measure of a physical therapy program should not simply be how efficiently we delivered visits, but whether the care helped move the injured worker toward meaningful recovery.
About Anthony Marcket
Anthony Marcket is a physical therapist with more than 20 years of combined experience in patient care and healthcare management. Across his career, he has built a record of exemplary performance in both clinical and leadership roles, which gives him a practical understanding of what it takes to deliver quality care and manage the operations that support it.
Anthony is a skilled teacher and team leader who helps the people around him meet their performance goals, both for the organization and for their own growth. His work is grounded in evidence-based practice, and he pairs that clinical foundation with his management experience to help organizations reach their current goals and pursue new ones.
About ION PT Network
ION PT Network is a national physical therapy management company built exclusively for workers’ compensation. Founded in 2017 by physical therapist Joseph Noel, ION manages PT care on behalf of payers, employers, and third-party administrators, coordinating treatment through independent providers with licensed clinical oversight at every stage of a case. More than half of ION’s staff are licensed therapists. Learn more at www.ionptnetwork.com.