Physical therapy can be an excellent means of treatment for injured workers who have experienced a musculoskeletal injury or who have undergone certain surgical procedures. In many cases, it may serve as the gold standard for treatment and recovery. However, as certain costs within workers’ compensation have declined over the years (i.e., pharmacy), the cost of physical therapy services has increased and is often the #1 driver of medical spend for employers.
Based on Sedgwick’s book of business, the average spend on physical therapy services increased by 6% this past year. Because physical therapy can be invaluable to the recovery process, understanding the environment more fully can enable employers to become more savvy consumers of these services and empower employees to prioritize their recovery.
Treatment plans
Physical therapists play a crucial role in helping to improve the functionality of an injured worker and foster a safe and healthy recovery and return to work. These highly trained specialists use their extensive knowledge in musculoskeletal injuries, human physiology, anatomy, kinesiology, and body mechanics to develop treatment plans based on the type of injury or parts of the body that are affected. By identifying functional goals, physical therapists determine appropriate exercises and therapies that progress the injured worker through an increased range of motion and weight bearing exercises.
Depending on injury assessment, early use of physical therapy treatment can be beneficial and enhance overall experience and results. Effectiveness of treatment is measured by monitoring and tracking the injured employee’s progress in meeting established goals and return to baseline as it relates to functional improvement and ability.
In determining whether to continue physical therapy and for how long, a physical therapist will typically look at the individual’s progression and functional abilities. Consistent participation in therapy alongside a home exercise program can contribute to a plan’s maximum effectiveness.
Physical therapy networks
An injured employee’s healing, recovery, and return to work should remain the focus around which treatment decisions are made. Informed employers are realizing that high-quality physical therapy networks can help ensure both quality care and cost management. Organizations are encouraged to look for physical therapists who are aware of functional workplace needs and experienced in treating work-related injuries.
While physical therapy services have not been immune to inflationary pressures, some cost acceleration can be linked to overutilization of services, without providing significant improvement or benefit to the injured worker. In other instances, “underdosing” may take place in which treatment lacks the intensity required for optimal recovery.
In reviewing data from Sedgwick’s book of business, we noted that 12% of claims include physical therapy that exceeds Official Disability Guidelines. Within this environment, Sedgwick is seeing increased interest in our physical therapy case management program. And the good news is these services are having a positive impact.
Here’s how they work:
In collaboration with our physical therapy network partner, we identify claims where there is a questionable treatment pattern. When the number of visits requested and/or provided exceeds 150% of the recommended number based on the Official Disability Guidelines or there is a lack of progression, the case is sent to our in-house physical therapist.
Assuming the claim needs clinical support and with approval from the claims examiner, our physical therapist will:
- Conduct a complete review of the medical history;
- Collaborate with the physical therapy provider, primary treating provider, claims team and injured employee to address any clinical concerns;
- Document all medical notes and clinical recommendations, and reporting tied to physical therapy visits prevented or additional insights demonstrating the impact made on the claim.
So far, our clinical PT program saves more than $1,500 per referral in unnecessary PT costs. Physical therapy is an important treatment for those injured on the job. Like other medical treatment plans, the provision of physical therapy services must be monitored to ensure quality, progression and recovery. Physical therapy is one more valuable tool that can be used to assist and support injured employees in resuming a productive lifestyle and safe return to work, and Sedgwick is committed to helping our clients and their employees get the most from these services.
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Tags: clinical approach, Helping people, injured employee, injured worker, Managed care, Medical care, Network, recovery