Mar 31, 2021 | Legislative Update
Here is a summary of legislative and regulatory developments and challenges for the first quarter of 2021 and their practical implications:
Major State Privacy Legislation: California and Virginia have new and comprehensive privacy statutes on the books, although the effective date for both initiatives is delayed until January 1, 2023.
The California Privacy Rights and Enforcement Act (CPRA) expands upon the current California privacy statute, the California Consumer Privacy Act (CCPA), by regulating not only the buying and selling of consumer information, but also its “sharing.” This term, while appearing to be broad, actually is narrowly defined as targeted advertising based on the consumer’s personal information. The focus of California’s privacy protection measures was and continues to be on commercial use of consumers’ personal information for sales and marketing purposes.
The Virginia Consumer Data Protection Act (CDPA) takes a different approach to consumer privacy, following many of the concepts found in the European Union’s General Data Protection Regulation (GDPR), such as the use of the terms “controller” and “processor.” A “controller” is an entity that determines the purpose and means of processing personal data (such as an insurer or TPA), whereas a “processor” processes personal data on the controller’s behalf (such as MedRisk).
There are a number of thresholds and exemptions that will relieve MedRisk and many of its clients and trading partners from CDPA compliance obligations. For example, the law applies only to entities that control or process the personal data of at least 100,000 Virginia residents during a calendar year. Further, entities exempted from the law include those that are subject to the federal Gramm-Leach-Bliley Act (applying to financial institutions) or that are “covered entities” or “business associates” under HIPAA. Notably, the law does not create a private right of action but restricts its enforcement exclusively to the Attorney General of Virginia, who presumably will limit regulatory action to intentional violations.
Implications: Although neither the California CPRA nor the Virginia CDPA is likely to have much impact on the operations of MedRisk or its trading partners, a potential trend toward a patchwork of comprehensive and inconsistent privacy laws is troubling. Most companies that operate nationally may be driven toward adoption of a lowest-common-denominator set of privacy standards that comply with state laws representing the binding constraint.
Mar 5, 2021 | Insights
Injuries involving the neck are among the costliest workers’ comp claims. What are the causes, and what role does physical medicine play in recovery?
This blog is part 1 of a two-part series titled “Neck Injuries in Workers’ Comp: Managing Pain and Controlling Cost.”
As many businesses have shifted to working from home throughout the pandemic, the effect of long hours spent at a poorly designed workspace has been felt by many Americans. But poor ergonomics is just one of the many causes of neck pain among today’s workforce. In fact, injuries involving the neck are the third most costly lost-time workers’ compensation claim, behind injuries involving the head/central nervous system and multiple body parts, averaging $61,510 per claim, according to the National Council on Compensation Insurance (NCCI).
Why are neck injuries such an important focus for workers’ compensation? In this blog, we take a closer look at the nature of neck injury, methods of treatments, and the important role played by physical therapists and chiropractors in recovery.
What Causes Neck Pain?
While a claim may carry a diagnostic code for neck injury, there are often other body parts involved. Because the neck supports the weight of the head, it is particularly vulnerable to injury. Unsurprisingly, hours hunched over a computer, smartphone or book can lead to muscle strain and neck pain. However, even something as seemingly unrelated as grinding your teeth can cause neck pain and restrict motion. Additionally, if a herniated disk or bone spur is present on the vertebrae of your neck, it can put pressure on the nerves branching out from the spinal cord, leading to nerve compression and amplifying neck pain. Neck injury is also a common effect of whiplash injury in accidents such as rear-end auto collisions, which can cause the head to be jerked back and forth, straining the soft tissues of the neck. All of these triggers have the potential to have a more significant impact as we age, as neck joints wear down over time.
Diagnosing and Treating Neck Pain
In order to diagnose neck injury, a physical exam is used to assess neck function – that is, a patient’s ability to move their head forward, backward, and side-to-side – as well as symptoms such as tenderness, numbness, and muscle weakness. In some cases, imaging tests such as CT scans, x-rays or MRIs may be ordered to investigate the root cause of injury.
Once a diagnosis is made, neck injury treatment is often put in the hands of a physical therapist (PT). Among the many benefits of a more conservative approach to neck pain treatment is the reduced likelihood of opioid prescription. One study found that initially consulting with a non-pharmacological provider such as a PT can decrease opioid exposure in the year following diagnosis. PTs and chiropractors help injured workers manage neck pain and regain neck function by normalizing alignment, teaching exercises to correct muscle flexibility and strengthen deficits, and educating them on proper posture and self-care. Early on, heat, ice, and electrical stimulation may be applied along with traction, using weights and pulleys to stretch the neck – an approach often used to address nerve root irritation. In certain instances, treatment may go beyond conservative care measures to include injections of corticosteroids or numbing medications such as lidocaine to relieve neck pain; however, surgery is rarely needed.
Conclusion
As a common and costly problem among injured workers, neck injury has been a longtime focus for MedRisk. How has treatment in this area changed over the years, and where is it headed? In the remaining blog in this series, we will learn more about the nuances of neck pain treatment from MedRisk’s International Scientific Advisory Board member Dr. Donald Murphy, DC, FRCC, and explore the unique ways a managed physical medicine program can support recovery from neck injury.
Mar 5, 2021 | Insights
Early Access to Physical Therapy and Specialty Care Management for American Workers with Musculoskeletal Injuries Study Underscores the Value of Care Management
The multiple benefits of early physical therapy have been documented in recent studies, but this article published in the Journal of Occupational and Environmental Medicine also recognizes the vital role of the care manager – the adjuster, case manager and other claims representative. Phillips et. al analyzed the workers’ comp claims of employees of a large, integrated healthcare system located in the Midwest for the study.
Researchers conducted a retrospective chart review of claims from 2009 that were not managed. These injured workers also received no early access to PT. Their outcomes were compared to those of workers whose claims from 2012 and 2013 were managed through a care pathway, included early access to PT and a high level of communication with all stakeholders. A third cohort was comprised of 2012 claims that were not managed through this path.
The managed path involved an initial visit with a physician and physical medicine provider (PT or occupational therapist) at the same time. If the patient met eligibility criteria, this was immediately followed by a PT evaluation that included an exam, patient education, treatment, home exercise program, referrals, and recommendations for work restrictions, written at the highest levels that would not hinder healing.
The program included seven pre-authorized physical medicine visits. Patients were observed performing core physical job demands during visits, and providers updated written work restrictions accordingly.
The PT or OT met with the physician and study coordinator who served as the care manager every week. They discussed the patient’s progress and any changes to the plan of care.
The care coordinator:
- Was the injured worker’s point of contact
- Communicated with all the providers, making sure everyone had information needed to make care decisions in a timely manner
- Managed all electronic health records
- Provided work restriction updates to Disability Department each week
Results
The managed claims lasting longer than 90 days had lower indemnity costs, fewer therapy visits, and lower total costs of claims than the ones that did not go through the care pathway. Researchers believed the rapid and regular work restriction updates accelerated return to work as did offering to let injured workers voluntarily test their abilities to meet the physical job demands at each session.
Because the study was conducted in a healthcare facility with its own employees and providers, not every employer or payer can control implementation of all the strategies. Yet there are takeaways to explore:
- Heightened communication with all stakeholders
- Pre-authorizing a number of visits
- Patient consultation with a physical therapist prior to treatment
- Identifying and overcoming barriers to early PT
As always, MedRisk stands ready to facilitate early and well-managed PT with our rapid response to referral guarantees, smooth scheduling, PT consultations, and patient education materials. We also have the EDI to quickly transmit electronic health records so our network providers are up to speed on the case before the patient arrives. We have the technology and the resources to help you make early, well-managed PT a reality.
Mar 4, 2021 | Insights
How has telerehabilitation helped physical medicine patients through the pandemic, and what role will it play moving forward?
Delayed recovery has always been a concern for the workers’ comp industry. However, when the pandemic hit last year prompting the cancelation of musculoskeletal surgeries as well as physical therapy treatment, interrupted rehabilitation became a very real threat for injured workers and employers alike.
Fortunately, offerings like MedRisk’s Platinum Grade Telerehabilitation program– launched over three years ago– had already begun to nudge telerehab into the mainstream for injured workers. What momentum did telerehab gain during the pandemic, and what benefits do patients stand to gain from this model as we adjust to a “new normal?”
Telerehab Pre- and Post-COVID-19
Even before the pandemic forced the temporary closure of many physical therapy clinics, getting to and from PT treatment was not always easy for injured workers. Patient location, commute time and level/nature of injury often posed a barrier to appointment compliance. Telerehab was seen as a way to overcome these barriers to care and serve as an alternative to on-site medical treatment.
Historically, state-to-state insurance coverage for telerehab has varied. But during the public health emergency, the Centers for Medicare & Medicaid Services and many states approved the use of telemedicine for physical medicine, at least temporarily – and patients have taken full advantage. MedRisk’s own telerehab numbers increased six-fold between January and April, and utilization has sustained above-average rates throughout the rest of the year.
A Different Goal & Approach
In this CompTalk presented virtually during the 2020 National Workers’ Compensation Conference, Brian Peers, DPT, MBA, MedRisk’s Vice President of Clinical Services and Provider Management describes how MedRisk quickly adapted to the access issue created by the coronavirus.
Before COVID-19, access to PT clinics wasn’t a big issue in the U.S. like it is in other countries that adopted telerehab earlier. Instead, convenience drove most of telerehab’s use. Patients in rural areas used it to avoid long distance commutes to a clinic. Some preferred telerehab to taking more time off work and spending it on the road. In the case of a traveling nurse practitioner who spent every night in a different town, telerehab was the reason she could keep working during her recovery.
When the pandemic created an access issue, MedRisk’s clinical team expanded its telerehab hours and criteria, which had been fairly conservative, to make sure patients had access to care. It turned out that more conditions than originally thought could be successfully treated via telerehab. Outcomes were good and patient satisfaction was high.
For example, Chris B. needed post-surgical PT after a quite involved rotator cuff surgery. Normally, he would start therapy in a clinic, but the clinic was forced to close the day he was supposed to start therapy. Delaying PT could have resulted in long-term mobility deficits and a decreased tolerance for lifting that would have prevented a return to full duty. Telerehab got him through the critical stage until clinics reopened and most of all he said, “I didn’t feel like I was totally out there on my own.”
Another patient needed to avoid clinics to protect her immune-compromised daughter, who was a cancer survivor. The patient could not shower alone, couldn’t stand for more than 5 minutes and had trouble getting out of bed after lumbar surgery following a major crush injury and needed immediate PT. Through telerehab, she progressed to standing during whole visits, lifting 10-15 pounds and being able to walk her dogs. When asked what she liked best about telerehab, she was quick to say, “I felt safe.”
MedRisk patients’ experiences align with the those captured in a recent patient satisfaction study published in The American Journal of Physical Medicine and Rehabilitation. Researchers surveyed patients and patient care advocates for pediatric patients who used telerehab during the pandemic.
Online surveys were completed after participating in a telerehab visit. Participants gave very good to excellent ratings for these areas:
- Addressing my concerns and questions
- Communication with my therapist
- Developing a treatment plan
- Execution of the treatment plan
- Convenience
- Overall visit satisfaction
- Value in having a future telehealth visit
Optional qualitative comments at the end of the surveys showed that respondents appreciated having access to the virtual services, which included physical therapy, occupational therapy and speech therapy.
Clinical Outcomes
For legislators, insurers, employers, and other stakeholders to be convinced of telerehab’s staying power, we need to also consider the clinical effectiveness of this model.
In the field of physical therapy, the utility and effectiveness of telemedicine has been analyzed in recent studies, and according to 2016 research, clinical outcomes associated with telehealth sessions may be equal to that of traditional in-person care services.
The Bini & Mahajan study compared the clinical outcomes of total knee replacement patients who underwent traditional in-person outpatient PT to those who participated in PT delivered through an asynchronous video-based tool. The 23 narrated videos created for the study demonstrated the same exercises taught in clinics, were each under 3 minutes in duration and featured on-screen text-based instructions.
On average, study patients engaged with the video-based model reported exercising for a mean of 47 minutes a day. They also logged in 49 times during the study period, posted 9 videos and 5 photographs, and sent 10 messages to their physical therapy providers. And, while patients utilizing the traditional care model logged 11 more minutes of exercise a day, they also reported a mean travel time to appointments of 75 minutes.
Patient satisfaction levels were high among both patient groups, with participants reporting that it was “easy or very easy” to communicate with their physical therapist. On top of this, the study authors write that “clinical outcomes following asynchronous telerehab administered over the web and through a hand-held device were not inferior to those achieved with traditional care,” suggesting that telehealth sessions of this nature are clinically equivalent to the in-person care model.
Conclusion
Telerehab has been proven to be a ready and viable solution during the COVID-19 crisis; however, it is important to remember that a public health emergency is not the only crisis injured workers can face in their recovery. Whether it’s an hour-long drive to the closest PT clinic, an injury that makes it difficult to drive or the weight of family responsibilities, virtual treatment will remain a valuable and cost-effective alternative for ensuring continuity of care for injured workers. For these reasons, industry experts are hopeful that telerehab is finally here to stay.
Feb 4, 2021 | Insights
Non-urgent medical services were suspended across the country in spring 2020 to reserve resources for COVID-19 patients. How is this expected to impact injured worker treatment and associated costs in the long term?
In an unprecedented move for the U.S. health care system, many medical services were halted in spring 2020 to reserve resources for a potential surge of COVID-19 patients. There had been little published on the long-term effects of this on injured workers until the Workers’ Compensation Insurance Rating Bureau of California’s October 2020 report “Cost Impacts of Medical Care Delays in the California Workers’ Compensation System.” In it, the organization analyzed how the suspension of California’s non-urgent medical care in March and April 2020 impacted the state’s workers’ compensation system and its expected influence on claims in the long term.
The study used historical indemnity claim information to examine the implications of first medical service delays on medical and indemnity costs, which were found even four years after injury. The report showed that injured workers with soft tissue injuries whose first medical service was delayed a month had higher indemnity and medical costs that persisted for years. These claims were also more likely to stay open longer, have a longer duration of temporary disability, and involve permanent disability. Similar results were found for other common workers’ compensation diagnoses like low back pain, sprain, and fracture.
Importantly, soft tissue claims with postponed first physical therapy treatment also had significantly higher medical and indemnity costs for years following injury compared to similar claims with no PT delays. These findings reinforce MedRisk’s commitment to helping injured workers receive prompt physical therapy treatment, with an average 4-hour turnaround time from referral to scheduling and just 2.6 days to initial evaluation.
Click here to read the WCIRB’s full report.
