2022 Outlook
Industry Trends Report
2022
Outlook
Guiding the Industry
(and Injured Workers)
to Recovery
Still recovering from the impacts of the pandemic, the workers’ comp industry must seek new approaches to optimize patient care, reduce duration and increase return-to-work rates in 2022. This requires a fresh look at best practices – especially in light of new findings on the treatment of injured workers. To effectively guide the industry (and workers) towards recovery, MedRisk has analyzed important trends seen over the past year and, in response, offers changes that may be made in the years to come.
Timing And Type Of Therapy Matters
Researchers have long agreed there are significant benefits to starting physical therapy early – that is, within 14 days post-injury, according to a 2020 Workers Compensation Research Institute study. To further reap these benefits, especially given the challenges the industry is facing in light of the pandemic, practitioners are shifting focus to one very specific type: manual therapy (MT).
42 %
decrease in temporary disability with early PT vs late post-injury PT
PT is understood to be the first-line treatment for musculoskeletal injuries before considering addictive opioid prescriptions and invasive procedures. Further, the 2020 study from WCRI says that for workers with low back pain, early initiation of PT (as defined by WCRI) is associated with lower utilization, lower costs and shorter duration of temporary disability.
8 x
more likely to experience a worsening disability without MT
A 2020 systematic review of randomized controlled trials updated a 2013 review exploring the value of MT (among other interventions) over the past several years. The 2020 review concludes by strongly recommending MT be integrated as an additional therapy. This supports earlier study results, which observed that patients who received only exercise (without MT) were 8 times more likely to experience a worsening disability compared to patients receiving exercise and MT treatment.
27 %
lower average medical cost per claim with early MT
In September 2021, WCRI released an initial study on MT for LBP claims. Researchers found that the temporary disability per claim was 22 percent shorter and the average indemnity payment per claim was 28 percent lower when workers received early MT compared with those receiving it later; a positive step towards more effective WC outcomes.
Trending at MedRisk
We’re seeing an increased focus on early MT in the industry and we’re delivering on it in our business. MedRisk data highlights patient age, surgical status and case complexity as three key factors that impact case duration and have been traditionally difficult to tackle. Our data – which has shown consistent results over the past five years – reveals the difference with and without early MT.
Age of Patient
PT utilization and visit duration usually increase with age – a concern for the WC industry as the workforce continues to age. The good news: the value of early MT also increases with age. MedRisk data shows that patients between the age of 51 and 60 are discharged 7 days sooner and those 61+, 9 days sooner when they’ve received early MT. As the industry navigates an aging workforce, a shift to more MT sooner will get employees back to work faster.
DAYS TO DISCHARGE
- 45 days
- 40 days
- 35 days
- 30 days
-
early mt
-
late mt
- 41-50
- 51-60
- 61+
AGE
Surgical Status
Following surgery, patients receiving MT later in their episode require more treatment over a longer period of time than those who receive MT early in the episode.
-
Early MT
-
Late MT
Complexity of Case
Early MT is especially valuable for complex cases involving more than one ailment. In such cases, early MT leads to fewer visits over a shorter duration.
-
Early MT
-
Late MT
MedRisk By the Numbers
MedRisk is the market leader in managing PT with an extensive national network of physical therapists, occupational therapists and chiropractors, and multiple solutions to help deliver the outcomes you need and with the care patients deserve.
Responding to Evolving Needs
Addressing Mental Health
Addressing Mental Health
The mental health challenge of the pandemic persisted throughout 2021 and has continued to impact recovery time. Looking forward, we expect anxiety and depression rates to align with COVID-19 recovery as underemployment, high hospitalization rates and other negative pandemic-related stressors remain.
What You Need to Know
- High anxiety and depression rates continue to dampen return to work rates for injured workers. Read more about the connection of psychosocial factors and patient outcomes in LBP here.
- The key to overcoming psychosocial barriers will be getting injured workers identified and treated early.
- Significant correlations have been found in research between depressive symptoms, fear of movement, pain catastrophizing and perceived injustice.
What You Can Do
- The Orebro-OMPQ tool is a 10-question questionnaire that, when used in conjunction with other data, identifies the presence of psychosocial risk factors and assigns a level of risk of poor outcomes. This helps practitioners take the best course of action before factors become barriers to recovery.
- Read more about psychologically informed PT practice in this Risk & Insurance article, highlighting MedRisk’s webinar “Psychosocial Barriers of Returning to Work”
Early PT & Patient Education
Early PT & Patient Education
What You Need to Know
- To drive more positive patient outcomes, early access to PT and patient education go hand in hand. It’s important to engage the patient from the beginning to ensure that they hear and understand the diagnosis and treatment. Read more.
- Studies show that an initial consultation with a PT provider may reduce overall healthcare utilization (i.e., opioid use) for patients seeking care for neck pain. Read more.
What You Can Do
- MedRisk’s PTConsult program identifies barriers to recovery – including psychosocial barriers – and recommends the best course of action to mitigate before they become true barriers to recovery.
- MedRisk’s consulting therapists can facilitate early PT to ensure optimal outcomes for workers.
Identifying the Right Treatment
Identifying the Right Treatment
With uncertain times, mental health concerns and rising PT costs comes a renewed focus on structure and guidelines to lean back on.
What You Need to Know
- By identifying factors early – flagging comorbid conditions, psychosocial barriers and other factors that impact care – providers can structure care within necessary guidelines to prevent interference with recovery. This accounts for the complexity of a given case and situations that cause delays in care (associated with the pandemic and rising mental health issues).
What You Can Do
- MedRisk’s International Scientific Advisory Board is the industry leader in the development and maintenance of evidence-based treatment guidelines specific to physical rehabilitation and utilization management protocols. Read more about the critical role of evidence-based guidelines in injured worker treatment here.
- These evidence-based treatment guidelines differ from most guidelines in a number of ways, most notably by providing recommendations for treatment choice, timing and sequence of interventions – effectively helping people get the right kind of therapy at the right time.
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.
State Privacy
California and Virginia released 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 is narrowly defined as targeted advertising based on the consumer’s personal information.
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.
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.
New York
Amendments to the Workers’ Compensation Board Medical Billing Disputes regulation became effective on November 1. These amendments require all objections to medical bills be filed with the Board simultaneously rather than sequentially. As amended, 12 NYCRR 325-1.25 now provides that the Board will deny any objections to payment of a health care provider’s bills that are not raised simultaneously in Form C-8.1, including objections based on legal, valuation or Medical Treatment Guideline grounds. The regulation is further amended to require payers, if the objection relates to the provider’s failure to obtain prior authorization, to provide with the filing evidence that the prior authorization request was actually denied.
Implications: The New York State WCB, in adopting these revisions, cited the need to expedite the resolution of medical payment disputes in the interest of administrative efficiency. The new requirements, however, appear to place the burden of improved timeliness primarily on insurers, employers and TPAs. The revisions may present challenges for payers’ claim staff in compiling and presenting all potential objections to medical bill payment within New York’s 45-day prompt payment timeline.
Pennsylvania
The Pennsylvania Commonwealth Court ruled that in 2016, the PA Department of Labor incorrectly calculated the PA fee schedule for PT evaluations and re-evaluations. The Court reasoned that CPTs 97161, 97162 and 97163 were not new codes, but rather replaced CPT 97001 with three codes that recognized varying levels of complexity. Similarly, CPT 97164 was not new but was merely a renumbering of the old CPT 97002. Thus, the fee schedule rates for the new codes should be based on the higher 1995 Medicare reimbursement rate, adjusted for inflation, rather than on then-current (and lower) 2016 Medicare rates.
The Court concluded that Pennsylvania PT providers have been shorted $20 to $21 per relevant service since January 20, 2017. The Court reversed the Secretary of Labor’s determination to the contrary and remanded the matter to the Department of Labor to “correct its 2017 Workers’ Compensation Fee Schedule,” which the Department promptly did.
Implications: The immediate practical implications of this decision are unclear. The court acknowledged that the corrected fee schedule will allow providers to submit supplemental invoices to WC payers if they choose to do so. MedRisk’s predominant provider payment methodology is based on per diem maximums rather than a percentage of fee schedule, so MedRisk has not seen an influx of requests for additional reimbursement. Longer term, however, the decision will encourage providers to negotiate for higher network reimbursements commensurate with the higher fee schedule rates for PT evaluation and re-evaluation codes.
COVID-19
Legislative measures as reported in the NCCI 2021 Regulatory and Legislative Trends Report have adopted and expanded presumptions that workers’ exposure to COVID-19 arises out of and in the course and scope of employment and, therefore, is a compensable injury or disease under WC. 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 has been considerably broadened. 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. Third, some bills are not limited specifically to COVID-19, but instead have terms that apply broadly to future unspecified infectious diseases or pandemics.
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 suffered by public safety personnel and armed service members. States that enacted legislation in 2021 expanding WC coverage for mental injuries included Connecticut, Idaho, Maine, Maryland, Nebraska, New Hampshire, Utah, West Virginia and Wisconsin.
North Dakota
On August 1, North Dakota became the first US jurisdiction to permit PTs to act as primary treating providers for WC claimants. The state’s exclusive state fund, Workforce Safety & Insurance agency, 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 WC 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.
Arizona
On May 5, Governor Doug Ducey signed into law HB 2454, which provides broad support for telehealth services in group health coverage. The measure clarifies existing law that Arizona endorsement of telehealth encounters applies to ancillary services and requires a carrier to reimburse health providers at the same level of payment for equivalent services, regardless of whether the services are provided in person or via audio-visual telehealth.
Specifically in relation to WC, the law allows medical examinations for WC claims to be conducted via telehealth with the consent of both the employee and the requesting party.
Implications: HB 2454, which was effective on its enactment, continues the broad trend toward state endorsement of telehealth when those services are medically appropriate. WC payers should incorporate telehealth into their injured worker treatment options if they haven’t done so already.
California
Two bills that posed significant challenges to California’s Medical Provider Network (MPN) system have been defeated, at least for now.
Assembly Bill 399 would have mandated that MPNs pay participating providers at California’s Official Medical Fee Schedule and would have prohibited negotiated rates below the regulatory fee. The measure would also have restricted MPNs’ ability to review provider bills for mistakes, fraud and abuse. Through intense opposition by employers and WC payers, the bill was held in the Assembly Insurance Committee without being voted on but has since been pared down to focus on the injured employee’s accessibility to MPN information. The minimum fee schedule component has been removed.
Assembly Bill 1465 would have required the Division of Workers’ Compensation to establish a state-run MPN (CAMPN) and would have permitted injured workers to select providers from this network in lieu of their employers’ MPNs. This measure is now a “study bill,” meaning that the California Commission on Health and Safety and Workers’ Compensation (CHSWC) will compare treatment delays and provider access issues between MPN and non-MPN claims and issue a report of its findings by January 1, 2023.
Implications: It is unlikely that either of these bills will be resurrected in the foreseeable future. AB 1465 met strong opposition from the business community, and the CHSWC study likely will counter the arguments of AB 1465 proponents that California injured workers lack access to high quality medical care via MPNs.
