2021 Industry
Trends Report

MedRisk has always been dedicated to understanding and advancing best practices.

Those best practices have proven to be even more critical for a nation struck by a global pandemic. By sharing the most meaningful changes we’ve seen in the wider community over the last year and the insights into where PT for workers’ comp is going next, we hope to make an even larger impact on increasing patient-focused care and improving return-to-work success for patients, providers and employers alike.

The Impact of COVID-19

COVID-19 has had an incalculable impact on the health and wellbeing of everyone. The following broad trends within the wider healthcare industry are expected to have significant impacts on managed physical therapy in workers’ comp.

Key Trends

45

weeks of surgical backlog
In March, the American College of Surgeons recommended suspending non-emergency and elective surgeries in the interest of patient safety and the redeployment of resources. Analysts estimate the resulting backlog of these surgeries and related medical procedures (including post-surgical physical therapy) will take nearly a year to bounce back from.

40%

of US adults struggling with mental & behavioral health
Depression, anxiety, trauma- and stressor-related disorders (TSRD), suicide ideation, and substance use all increased significantly by June 2020 due to the pandemic. Some researchers estimate depressive disorders are four times what they were for the same period in 2019.

123%

increase in opioid overdoses
According to the American Medical Association (AMA), more than 40 states have reported a significant increase in opioid-related deaths this year compared to 2019, highlighting the critical importance of effective alternative treatment paths such as PT and other conservative care approaches.

Trending at MedRisk

MedRisk data shows significant fluctuation in the volume of post-surgical PT this year that correlates closely to the postponement of non-emergency surgeries due to COVID. As the medical community attempts to catch up we expect a higher number of post-surgical PT referrals and even pre-surgical physical therapy to help deconditioned patients prepare for postponed surgery. We also expect longer duration overall due to both delayed surgical and non-surgical medical care, a prediction supported by recent research from the WCIRB in California.

Psychosocial Barriers to Recovery

MedRisk’s data suggests injured workers are being hit especially hard by the pandemic-related rise in depression and anxiety. These psychosocial factors can be significant barriers to recovery leading to longer duration of PT care and can negatively impact return-to-work. As such, the workers’ comp industry should brace itself for both an increase in PT spend due to longer duration and higher total medical and indemnity claim costs.

Legislative Recap

MedRisk gathers the latest legislative and regulatory developments and challenges each quarter. Here is a full summary of significant movements in 2021 and the implications for 2022.

The Department of Workers’ Claims has proposed Administrative Regulation 803 KAR 25:260, which adopts the ODG treatment guidelines broadly applied to non-emergency medical care. Treatment recommended in the guidelines would be presumed to be reasonable and necessary. Conversely, treatment not recommended or not addressed in the guidelines would require preauthorization, with the burden placed on the provider to justify the proposed treatment. For retrospective bills, payers would not be responsible for paying for treatment outside the guidelines unless it (a) was provided in a medical emergency, (b) was authorized by the payer, or (c) was approved via dispute resolution by an administrative law judge.

Implications: Once formally adopted, the new Administrative Regulation will add Kentucky to the list of jurisdictions that use independently developed interstate medical treatment guidelines to promote effective medical care while reducing friction within the WC system. The treatment guidelines apply to all treatment administered on and after September 1, 2020.

Senate Bill 381 adds a new section to the existing statute (NRS 616B.527) permitting payers to contract with preferred provider networks and giving payers the right to require injured workers to obtain healthcare services (including physical therapy) within the preferred provider organization. The new law imposes a qualification on employers’ and insurers’ ability to direct care: the injured worker must choose from the employer’s/insurer’s list of physicians and chiropractors only if the employer/insurer maintains a list of 12 physicians for each of the enumerated physician specialties and for 12 chiropractors.

The new law requires employers and insurers to maintain a list of physicians and chiropractors only, but not a list of PTs. If the payer doesn’t provide a list that complies with this requirement, the injured worker can select a physician or chiropractor from an approved list compiled by the WC Section of the Division of Industrial Relations. Further, the new law requires employers and insurers to file with the DIR an updated list of physicians and chiropractors by October 1 of each year.

Implications: The statute considerably restricts what has been a permissive approach to employer direction of care by imposing a “panel” requirement for physician specialties and chiropractors.P

The New York State Workers’ Compensation Board adopted several amendments to its regulations to conform them to the Expanded Provider Law taking effect on January 1, 2020. The amendments to the regulations implement the statute by detailing the billing process to be followed by newly authorized providers. The amendments clarify the regulations in three ways. First, the amendments provide that payers subject to the regulations include third party administrators as well as employers and insurers.

Second, the amendments add as new provider types protected by the regulation any authorized medical provider of Medical Care (defined broadly in the underlying statute to include physical and occupational therapists and acupuncturists, among others). Third, the amendments simplify the billing dispute process to eliminate the “continuous course of treatment” concept and to extend time to submit bills from 90 days to 120 days from the date of service. The amendments have an effective date of January 1, 2020.

Implications: The proposed amendments primarily conform the current regulations to the new statute and bolster the WCB’s enforcement powers over all payers, including TPAs. Lengthening the permitted provider bill submission timeline from 90 to 120 days after date of service, however, may necessitate changes to payers’ late-bill denial processes. The amendments retain their status as proposed rather than final, but payers may be well-served to comply with the proposed amendments sooner rather than later.

Legislative activity in 2020 has been focused primarily on the COVID-19 pandemic. The NCCI has identified 89 separate bills or executive orders nationwide that expand the compensability of WC to employees contracting the coronovirus, 83 of which have either been enacted, issued or are in committee. While many of the executive orders will expire or have limited scope, COVID-19 pandemic and compensability will have a significant impact on WC payer claim operations.
During the pandemic and in the absence of federal legislation clarifying CMS rulemaking authority over telehealth services for physical medicine, state workers’ compensation agencies who had previously prohibited telerehab or restricted access have issued month-to-month emergency rules extending authorization. Increased access will most likely continue through 2021. Even after the pandemic subsides, MedRisk anticipates the industry to continue to embrace the use of telemedicine services, including telerehabilitation.

Research & Insights

MedRisk by the Numbers

90%

DECREASE IN TEMPORARY DISABILITY WITH EARLY PT VS LATE POST-INJURY PT

97.7%

OF NETWORK PROVIDERS AGREE WITH MEDRISK CLINICAL RECOMMENDATIONS

98.1%

PATIENT SATISFACTION

0

LAY-OFFS OR FURLOUGHS DURING COVID-19 SHUT DOWN

4

HOURS TO SCHEDULING

2.6

DAYS TO INITIAL EVALUATION

191,273

TOTAL NETWORK PROVIDERS

394,435

INJURED WORKERS TREATED

Prior Trends Reports

Scroll to Top
The 2026 Trend Report is now available.
This is default text for notification bar