Dec 7, 2021 | Insights
Assessing injured workers quickly, starting physical therapy (PT) early and when appropriate, getting them manual therapy (MT) quickly will lead to better outcomes for injured workers.
Researchers have found that there are big benefits to starting PT early. In fact, fewer diagnostic tests, opioid prescriptions, pain management injections and lumbar surgeries ultimately lead to faster return to work and lower total medical costs of claims. This begs the question: Is there a specific PT treatment that further influences the utilization and costs of medical resources and outcomes?
All eyes are on MT, a hands-on therapy that improves range of motion and reduces pain. Many practitioners and managed care professionals have long believed that early MT could improve outcomes.
To help fill information gaps in medical and healthcare policy research regarding MT, the Workers Compensation Research Institute (WCRI) analyzed low back pain (LBP) claims in 28 states that did not have surgery and received MT. WCRI compared costs and outcomes between claims with early MT (within 14 days of the worker starting PT) and late MT, as well as claims with and without MT.
Researchers including a member of MedRisk’s International Scientific Advisory Board, Kathryn Mueller, MD, found that early MT was associated with lower utilization of medical services, lower medical and indemnity payments, and shorter temporary disability duration. In fact, the average medical cost per claim was 27 percent lower, the average indemnity payment was 28 percent lower and temporary disability duration was 22 percent shorter when workers received early MT compared with those receiving it later.
While this is the first of many investigations needed to assess the overall cost-effectiveness of MT, the study is a positive step towards more effective WC outcomes.
This also supports MedRisk’s PTConsult program, where a consulting therapist can help identify people who need MT and recommend they get it quickly. Through our extensive network, electronic data interfaces (EDI) and clinical expertise, we partner with clients to facilitate early PT and ensure optimal outcomes for workers.
To read the full study, click here.
Outcomes Associated with Manual Therapy for Workers with Non-Chronic Low Back Pain. Dongchun Wang, Kathryn Mueller, and Randy Lea. September 2021. WC-21-23.
Nov 9, 2021 | Company News
King of Prussia, PA (November 9, 2021)
MedRisk is pleased to announce that our own Jill Carnahan, PT, DPT was a finalist for this year’s Comp Laude® awards in the medical provider category. The awards program aims to change the narrative of workers’ compensation to a more positive dialogue and bring all stakeholders to the table to participate in the conversation.
When Jill Carnahan joined MedRisk in 2016, she made the shift from patient care to peer-to-peer review. While she enjoyed her work, she missed patient care. So, when MedRisk developed its own telerehabilitation program, she dove headfirst into what was uncharted waters at the time.
Since then, Jill has been on the front lines of telehealth, building a one-of-a-kind team of physical therapists (PTs) and helping develop a product that is secure and effective. She is a pioneer in ushering remote PT into the workers’ compensation industry. Before the pandemic, injured workers had mostly gravitated to telerehab for convenience. But when the pandemic struck, things changed quickly. MedRisk patients (and the workers’ comp industry as a whole) were suddenly ready to go virtual and Jill was there to lead and provide that much needed care.
Today, she spearheads MedRisk’s telerehabilitation program, seeing patients, managing its team of telerehab physical therapists and conducting telephone consultations following work-related injuries.
Because of her work in the telerehab space, she holds the unusual distinction of being a licensed PT in 33 states. Jill helps patients across the country and has received glowing reviews throughout her career. Her patients rave about her empathetic listening, easy-to-understand explanations and flexible care.
Jill earned her Bachelor of Arts degree in Psychology and Doctorate in PT from the University of Delaware in Newark, Delaware. She worked as a graduate assistant at the university’s PT clinic prior to graduating. She then worked as a staff PT at Jeanes Hospital in Philadelphia for a short time before moving to MossRehab. She worked there for over 10 years and successfully developed and grew the pelvic rehabilitation program for the Einstein Health Network.
We are so proud of Jill and her innovative team. Join us in congratulating Jill!
Nov 8, 2021 | Company News
King of Prussia, PA (November 8, 2021)
A chance encounter with a physical therapy pamphlet while serving in Vietnam changed the trajectory of Paul Beattie’s career. Today, his research is changing the world of PT: in the military, in workers’ compensation, the wilderness and beyond.
A charter member of MedRisk’s International Scientific Advisory Board (ISAB), a practicing PT for over 45 years and a Clinical Professor Emeritus in the Department of Exercise Science at the University of South Carolina, Paul Beattie, PT, PhD, FAPTA, is dedicated to improving lives through PT.
Particularly the lives of fellow veterans and active – duty members of the U.S. Army.
“Being a combat veteran is a kaleidoscope of good and bad experiences that you have for the rest of your life,” reflected Beattie. “I’m really lucky to have gotten through that and I’m grateful to have gone to college and become a PT.”
A U.S. Army veteran of Vietnam ’69 – ‘71, Beattie attended Quinnipiac College (now University) under the wings of Harold Potts, Chair and Founder of the PT Program—and WWII veteran looking to give other veterans a chance.
Beattie’s first job outside of PT school was for the Department of Rehabilitation Medicine at Manhattan Veteran’s Hospital. As his experiences as a PT evolved through the years – from student to practicing clinician to researcher to professor – Beattie eventually found himself in the same shoes as Potts: when veterans applied to PT school, he would always make a point to help them and he continues looking out for them today. A military family, Beattie’s son currently serves as a U.S. Army Captain.
It’s no question that the military lifestyle has made its mark on Beattie. Now, he is making his mark on the military with his unique PT experience and research.
PT Service & Research for Military Applications
For example, through his work with the Armed Forces Chaplaincy Center from 2004 – 2016, Beattie provided chaplain candidates with skills to help them support wounded, injured and emotionally distraught individuals in dangerous battlefield environments.
More recently, Beattie has become the co – principal investigator for a military team of PTs, pharmacists, physicians, nurses and clinical trial support members for a study funded by a grant from the Department of Defense to assess the effectiveness and efficacy of a drug targeting bone growth. Forteo, known generically as Teriparatide, is currently used to treat osteoporosis. The study is investigating the drug’s use to accelerate bone growth after a broken bone or stress fracture during military training or duty.
Based in the largest U.S. basic training facility at Fort Jackson in Columbia, South Carolina, the study has significant implications for active – duty force readiness. Stress fractures are common – up to 20 percent of trainees will get them – and this drug has the potential to speed healing, allowing members to stay on site for training or embedded with teams, rather than be evacuated.
“This could be an enormous advance for sports medicine implications, military implications, injured workers and the geriatric population,” Beattie said.
Beattie’s work has been instrumental in PT military applications. And the reverse is also true: Beattie is focused on extending military applications of PT into other areas, some conventional and others emerging.
Emerging Application: PT Military Model in the Wilderness
A common practice in the military is embedding PTs with special forces units such as Green Berets and Navy Seals. This model allows PTs to treat these highly elite tactical athletes onsite more effectively and prevent evacuation from often remote, difficult environments.
Recently, Beattie’s interest has been extending this model to wilderness applications with PTs as members of search and rescue, firefighter or park ranger teams.
“If we can prevent injuries and reduce evacuations and keep people functioning at point of contact, it’s a win – win situation,” said Beattie.
Beattie is currently promoting that PTs with unique skills embedded during fire season can significantly help injured wildland firefighters, in which the overwhelming majority of injuries reported are musculoskeletal: lower limb, back and shoulder sprains and strains. By embedding PTs close to the fire line, evacuations can drop up to 20% – saving enormous time and resources when they are needed most.
PT – First Care for Musculoskeletal Injuries
PT as a point of contact responder is becoming more common in conventional applications as well. For example, North Dakota recently began allowing injured workers with musculoskeletal injuries to see PTs directly without going to physicians first. Beattie agrees on this direction.
“During the COVID pandemic, hospitals have had problems with staff depletion as physicians and nurses shifted to work in the ICU,” said Beattie. “In emergency departments, which is a point of contact for acute musculoskeletal pain, PTs have been taking over as the primary care provider.”
He continued: “Compelling data has shown that when PTs are embedded in EDs, patients are seen faster and the number of images and other lab studies are reduced, saving costs and improving outcomes and overall patient satisfaction.”
Beattie’s interest in embedding PTs at important touch points – such as austere and wilderness environments and even the ED – is a testament to his dedication to progressing the PT profession.
Beattie’s Impact on MedRisk’s ISAB
As an APTA Catherine Worthingham Fellow, Beattie’s work is recognized as resulting in lasting and significant advances in the science, education, and practice of the PT profession.
Beattie continues to sit on MedRisk’s ISAB, offering his truly unique perspective and contributing to the Evidence – Based Guidelines in Injured Worker Treatment.
“It’s an incredible opportunity to meet so many talented colleagues,” said Beattie. “The ability to sit down with peers to synthesize evidence, appraise it and come out with a product – which is the guidelines – is challenging, but gratifying.”
Oct 5, 2021 | Insights
Communication is the heart of the relationship between a physical therapist and patient. Here are four guidelines to help improve patient conversations—and create superior outcomes.
After an initial evaluation, PTs will typically prescribe exercises and provide low back pain (LBP) patients with information about their diagnosis, prognosis and plan of care.
A positive interaction between the patient and physical therapist during this evaluation has been linked with reduced pain and disability, as well as a higher satisfaction with treatment. In fact, studies have shown that the initial evaluation process may produce small but significant therapeutic effects related to pain, fear-avoidance and functional measure of mobility and sensitivity.
But this is only true if the therapist successfully delivers the advice and the patient receives and retains the intended message.
Unfortunately, there are cases in literature that show inconsistencies between a PT’s self-assessment and a patient’s perception. This is not just a communication breakdown but a risk to the patient’s overall care.
For example, patients with spinal problems need to understand that back pain is generally benign and activity is key to recovery. If they do not perceive this message, they have a higher risk of disability and lower treatment satisfaction 6 months after treatment.
In a study published in Wiley Physiotherapy Research International, all patients remembered the PT’s first piece of advice, with diminishing retention for the second and third pieces of advice. Simultaneously, PTs underestimated success of message delivery in the first and second items of advice and overestimated success for the third.
While the disconnect may have been marginal in this study, there were a number of factors at play that enhanced the patient-therapist interaction. Based on this research, here’s what can be done to ensure PTs successfully communicate and patients actually listen.
How to Make Sure Patients Listen: Four Guidelines
#1. Use Shared Decision Making
Shared decision making is a consultation process in which a clinician and patient work together to make a health decision. It involves discussing options, benefits and harms and considering patient values, preferences and circumstances.
Taking a collaborative approach of the clinical evaluation and involving patients throughout the diagnostic process helps ensure that the patient understands what the provider recommends—thus bolstering retention of advice and exercises.
#2. Prescribe Simple Exercises
It’s one thing to retain a provider’s advice for managing LBP. It’s another to actually follow it.
Patients are more likely to participate in exercise programs that consider their preferences, circumstances and past exercise experiences. With that said, patient adherence improves when providers prescribe:
- A limited number of exercises
- Simple yet effective exercises
- Exercises that are easy to include in daily life
#3. Address Patient Concerns
A patient’s worries, fear-avoidance, individual beliefs and experiences with LBP can negatively impact their prognosis and overall treatment outcomes.
For example, a patient may be influenced by a family member’s experience with similar pain.
It’s important to have a dialogue about these concerns and then develop specific and reasonable management strategies that addresses a patient’s worries.
#4. Identify & Address Patient Expectations
Finally, patients come into physical therapy with a set of expectations.
For the most part, patients expect specific, tailored exercises. They also expect investigations that lead to a diagnosis and an explanation of what actually caused it.
Opening a dialogue about these expectations—and addressing them—will further improve communication and patient outcomes.
Conclusion
Patient-therapist communication is critical and it all starts at the initial evaluation. As the industry continues to prioritize patient-centric care, it’s important to engage the patient from the beginning to ensure that they hear and understand the diagnosis and treatment.
Because when patients remember what PTs tell them, they are more likely to adhere to exercises and see improvements with their LBP.
MedRisk’s patient-centric approach to managed physical medicine starts with its PT Consult service: a consultation between an on-staff PT and the patient in advance of treatment. PT Consult prepares patients for what PT is like and the physical benefits it brings, such as strength, pain relief, mobility and recovery. There is a screening for any psychosocial factors that could impact recovery and the consultation helps set the patient’s expectations for therapy and what the recovery journey may look like, establishing a positive mindset as they get ready to start with their MedRisk provider.
Supp, G, Schoch, W, Baumstark, MW, May, S. Do patients with low back pain remember physiotherapists’ advice? A mixed-methods study on patient-therapist communication. Physiother Res Int. 2020; 25:e1868.
https://doi.org/10.1002/pri.1868
Sep 28, 2021 | Legislative Update
Here is a summary of legislative and regulatory developments and challenges for the third quarter of 2021 and their practical implications:
Legislative Action & Trends: As reported in the recently published NCCI 2021 Regulatory and Legislative Trends Report, recent state legislative activity has focused heavily on the COVID-19 pandemic. These legislative measures have adopted and expanded presumptions that workers’ exposure to COVID-19 arises out of and in the course of and scope of employment and therefore, is a compensable injury or disease under workers’ compensation. Five states that recently expanded presumptions are Alaska, Illinois, Minnesota, Vermont and Wyoming.
Further, legislative measures establishing a presumption of work-relatedness are broadening employers’ WC exposure in three additional ways. First, the original list of workers subject to the presumption (e.g., health care workers and first responders), has been considerably broadened to include many less dangerous employee classes as seen in statutes in Texas and Virginia.
Second, many bills do not have sunset dates tied to a time-limited COVID-19 emergency declaration (typical of a gubernatorial executive order), so they will not expire when the pandemic subsides. Rather, they will become a permanent part of the WC benefits landscape.
Third, some bills are not limited specifically to COVID-19, but instead have terms that apply broadly to future unspecified infectious diseases or pandemics, e.g., statutes in Tennessee and Washington.
Another societal trend finding its way into legislation affecting WC compensability arises from public awareness of the serious and lingering health effects of post-traumatic stress syndrome (PTSD) suffered by public safety personnel and armed service members. States enacting legislation in 2021 expanding WC coverage for mental injuries include Connecticut, Idaho, Maine, Maryland, Nebraska, New Hampshire, Utah, West Virginia and Wisconsin.
Implications: The third quarter of 2021 was relatively quiet from a legislative perspective, with many legislatures adjourned or in special session focused on issues not specifically directed at WC. With the arrival of autumn, however, most state assemblies will reconvene to continue their consideration of pending bills that, while not narrowly targeting WC, may have a large impact on WC claims in the longer term.
North Dakota: On August 1, North Dakota became the first US jurisdiction to permit physical therapists to act as primary treating providers for workers’ compensation claimants. The state’s exclusive state fund, Workforce Safety & Insurance agency (WSI), issued guidelines permitting PTs to perform stay/return to work planning, correspond with WSI regarding the injured worker’s injury, provide capability assessments every two weeks, determine maximum medical improvement to guide claim management and refer the patient to most other health care providers without WSI prior authorization.
Implications: Allowing patients to have direct access to PTs without requiring a referral from a physician is common within group health plans, but the North Dakota statute and guidelines break new ground for workers’ compensation claimants. North Dakota employers currently have the option of requiring injured workers to treat with the employer’s choice of Designated Medical Provider, however, so the immediate impact on employers may be limited. Nevertheless, this innovation bears watching as a means of delivering prompt and cost-effective health care and medical management to claimants who have experienced musculoskeletal injuries.
