As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk has always been dedicated to understanding and advancing industry best practices. Our commitment to delivering better return-to-work success for patients, providers and employers requires MedRisk to stay responsive to treatment and technology trends. We’ve compiled some of the more meaningful changes we’ve seen in the wider community over the last year, as well as the changes MedRisk has made in response to where we see managed physical medicine for workers’ comp going next.
MedRisk is the largest specialty managed care organization in the workers’ compensation
industry that is dedicated to physical rehabilitation.
treated in 2017
Fewer Surgical Cases for Low Back Pain From 2013-2017
MedRisk has seen a significant reduction in post-surgical cases for low back pain—a trend that is in line with the rise of a conservative care-first approach to improve outcomes and reduce costs.
of Patients Prescribed Opioids for Chronic Pain Misuse Them
Opioid misuse has ballooned to epidemic proportions since 2013. PT is now recommended by the CDC as the preferred first treatment for chronic pain and an effective alternative to opioids in many cases.
Reduction in Post-op Care with Pre-op Education
Research over the last five years has validated the importance of patient education in driving positive outcomes, efficient return to work and cost savings. PT sessions often play an essential educational role.
Low Back Pain
Pain in Shoulder
Research shows acupuncture can reduce the severity of low back pain suggesting it is a viable alternative to opioids and supports the trend towards conservative care. MedRisk’s expert network of providers includes 1,425 acupuncturists nationwide. Low back pain (ICD10 M54.5) was the number-one diagnosis code for MedRisk referrals to an acupuncturist in 2017.Learn More
Pain in Shoulder
Pain in Knee
Low Back Pain
Are shoulder and rotator cuff problems the new low back pain? Evidence-based research has shown that conservative care can reduce surgical intervention for low back pain. Can the same be true for shoulder pain? According to our numbers, pain in the shoulder is now the number-one diagnosis for cases with post-surgical PT.Learn More
MedRisk gathers the latest legislative and regulatory developments and challenges each quarter.
Here is a full summary of movements in 2017 and the implications for 2018.
The Department of Industrial Accidents has revised the regulation governing WC Utilization Review, which affects them by:
The DIA’s Office of Health Policy heavily regulates these detailed and unique requirements. As such, payers should review the revised version of 452 CMR 6.00.
Legislature was recently established that created a one-year bill submission period for MD providers, where there previously wasn’t one.
Starting October 1, 2017, the date will be extended to 12 months from what used to be a date of service, the acceptance of the claim by the payer or the determination of compensability by the Commission. The period can be extended to three years if the WC Commission finds there is good cause for the delay.
Colorado’s Division of Workers’ Compensation (DWC) adopted regulations defining acceptable standards for telemedicine. The DWC Utilization Standards now require the use of audio and video equipment during telemedicine sessions for the provider to diagnose and evaluate more effectively. Using these tools, therapists are expected to alter the treatment plan, medications and any specialized therapies.
Colorado DWC is shifting its focus to telemedicine that puts a unique emphasis on worker rehabilitation and return-to-functionality. The creation of these regulations shapes the emergence of telemedicine as an effective and efficient claims management system.
For services after January 1, 2017, the new statute time-bars provider bills that aren’t received within 12 months of the date of service or hospital discharge.
California did not have a timely bill law previously; establishing this puts payers’ internal payment policies and contractual agreements with providers and networks into question. The DWC is authorized to adopt rules and implement the 12-month limit, including reasonable exceptions.
Texas enacted legislation to give the Division of Workers’ Compensation (DWC) greater control over work-hardening and work-conditioning programs.
The Senate Bill 1494 removes automatic exemption from pre-authorization and concurrent review which CARF-credentialed facilities previously enjoyed. Effective September 1, 2017, the amendment permits the DWC to reinstate exemptions for certified facilities if the agency determines exemptions are appropriate.
These programs were targeted by the DWC as potential sources of fraud and abuse, so the removal of the exemption gives the DWC regulatory discretion to set standards to control costs and prevent excessive or unnecessary treatments.
The Industrial Commission of Arizona adopted a new fee schedule based on Medicare’s Resource-based Relative Value Scale that applies for services rendered on or after October 1, 2017. Not included in the final rule is an earlier staff recommendation that would require networks to pay participating providers participating at 90% of either the fee schedule rate or of the full amount of any negotiated discount rate payable to the network.
Virginia’s customized fee schedule will go into effect January 1, 2018, replacing a system based solely on provider charges. One of the principal legislative goals in creating the fee schedule is to reduce the volume of provider fee disputes. The fee schedule uses six geographic “medical communities” and seven provider groups. Physical and occupational therapy are included within the “Providers of Outpatient Services” group along with chiropractic, dental, acupuncture and ambulance services.
According to the ground rules governing the establishment of the fee schedules, “fee schedules were designed to achieve revenue neutrality within each provider group and medical community combination.”
A preliminary review completed by MedRisk, however, suggests that for some prominent PT services within major metropolitan areas, the regulatory “maximum fee” will be appreciably lower than pre-fee schedule payments.
The Pennsylvania Bureau of Workers’ Compensation responded to a PA Supreme Court decision invalidating the AMA Guides to the Evaluation of Permanent Impairment as a standard for disability ratings by suspending all independent rating evaluations.
The Journal of Orthopedic & Sports Physical Therapy published a study testing the effectiveness of manual therapy compared to surgery on the functionality of hands with carpal tunnel syndrome. Studying a year of either treatment, the trial found differences between the two modes of treatment. Manual therapy (like physical therapy) had patients seeing recovery results in function in as little as one month into consistent treatment.
A study published in the journal Physical Therapy found that early physical therapy for patients with non-traumatic knee pain (NTKP) was linked to a lower use of opioids and surgery. NTKP is common in adults 65+ and evidence-based guidelines recommend early use of rehabilitation, but with limited access to information about these options, some turn to narcotics for treatment.
Exposure to early outpatient rehabilitation resources for NTKP patients was associated with lower odds of narcotics use. Not only that, but an early referral for outpatient rehabilitative services means reducing overall costs and length of treatment.
Beneficiaries newly diagnosed with low back pain that receive physical therapy for their first type of treatment incur fewer costs when it comes to Medicare A/B, on average. In the time surrounding diagnosis and in the years following, patients who chose PT over injections or surgeries reduce the average total Medicare costs. That cost is significantly lower when those same patients begin therapy within 45 days of their diagnosis.
This study outlines the effects of therapy on low back pain and the benefits and cost-saving capabilities when PT is chosen as the first line of defense.
Research comparing costs related to telerehabilitation versus conventional physiotherapy following arthroscopic subacromial decompression surgery suggests telerehab offers a viable a way to reduce the overall cost of patient care and provide a more accessible path to recovery. Telerehabilitation reduced the post-surgical ASD treatment costs to patients and healthcare providers by 29.8%.
This study adds an economic assessment to the growing body of clinical evidence in support of telerehabilitation.
Recent research compared the use of telerehabilitation for the treatment of musculoskeletal conditions versus standard in-person practices.
The study revealed telerehabilitation is just as effective at improving physical function and reducing pain as standard practices. Additionally, they found that using telerehabilitation in conjunction with face-to-face interventions produced more favorable physical function than standard care alone.
The researchers concluded that real-time telerehabilitation is as effective as conventional methods of healthcare delivery to improve physical function and pain in musculoskeletal conditions.
ATA Telerehabilitation Special Interest Group (SIG), which consists of healthcare practitioners and technology specialists, made key updates to the guidelines document for Telerehabilitation. These updates include:
The workers’ compensation industry is set to experience its next technological evolution: Telerehabilitation. Innovative companies, clinicians and managed physical medicine organizations are complementing hands-on PT with the latest advances in telerehab to great success. Patients and payers alike are seeing practical benefits such as:
To successfully apply telerehabilitation in today’s workers’ comp environments, however, requires some specific knowledge. The latest guide from MedRisk includes the information you need.