May 5, 2021 | Insights
Can effective provider communication minimize time away from work for injured workers?
A recent article published in Medical Care looked at how healthcare provider (HCP) communication can facilitate the successful return to work (RTW) for injured workers.
There is a growing recognition among HCPs that injured worker treatment must go beyond biomechanical therapies in order to help the patient achieve optimal outcomes. Patient education and communication can be important components of minimizing time loss after injury. The authors analyzed linked survey and administrative claims data from workers’ compensation recipients to assess whether HCP communication could predict time off work and whether this impact could be hampered by a stressful HCP experience.
The report found that sharing a likely RTW date with patients reduced the odds of future time loss, regardless of the stress of their HCP experience. In addition, HCPs may be able to reduce the length of future time loss by reaching out to stakeholders in the return-to-work process and possibly through prevention discussions, but only in low-stress encounters.
MedRisk helps facilitate patient education by providing informational materials and scheduling a consultation with an on-staff PT for patients prior to treatment. Insights from these conversations, along with ongoing progress notes, are communicated to stakeholders to support the injured employee and help mitigate hurdles on the path to recovery.
To read the complete article, click here.
Lane, T. J., Lilley, R., Black, O., Sim, M. R., & Smith, P. M. (2019). Health care provider communication and the duration of time loss among injured workers. Medical care, 57(9), 718-722.
Apr 12, 2021 | Insights
How can PTs empower patients to self-manage their condition, even after their initial treatment has ended?
In a recent article published in the Journal of Orthopaedic and Sports Physical Therapy, Hutting et al contend that self-management strategies are integral to managing chronic musculoskeletal disorders and discuss how physical therapists (PTs) can provide self-management support throughout the course of treatment.
What types of self-management strategies are most effective when treating low back pain and other persistent musculoskeletal disorders? In their discussion, the authors recommend an individualized, holistic approach to self-management that addresses biomechanical, psychosocial and individual characteristics. Research has shown that while passive self-management approaches (e.g., hot packs) increase the likelihood of pain behavior and disability, active strategies (e.g., exercise) can decrease the probability of these experiences.
The authors recommend that PTs integrate self-management strategies into treatment by: (1) working with the patient to identify any barriers or goals they may have, (2) identifying strategies to reduce or avoid symptom exacerbation through problem solving, and (3) discussing ways to measure the effectiveness of self-management with the patient.
MedRisk supports an active, person-centered approach to treatment, beginning with a consultation prior to treatment. During the consultations, an on-staff PT is able to educate patients on the importance of physical therapy, describe what to expect and address any initial barriers to recovery.
To read the complete article, click here.
Hutting, N., Johnston, V., Staal, J. B., & Heerkens, Y. F. (2019). Promoting the use of self-management strategies for people with persistent musculoskeletal disorders: the role of physical therapists. journal of orthopaedic & sports physical therapy, 49(4), 212-215.
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.
Sep 15, 2020 | Insights
A recent publication explores the essential role of physical therapists in helping patients develop self-management strategies to combat musculoskeletal pain.
In a recent article published in the Journal of Orthopaedic & Sports Physical Therapy, Hutting et al discuss the issue of persistent musculoskeletal pain, including low back pain, in a global context and the dialogue surrounding effective treatment approaches.
The authors advocate for a “person-centered approach,” with physical therapists encouraging more active participation from the patient. They contend that treatment focused on self-management gives patients the skills and knowledge to actively manage their pain.
The self-management approach means educating patients on the biomechanical and psychosocial aspects of their conditions and involving them in decision making. The goal is to equip them to self-regulate their pain well after PT sessions end.
Recommendations include the formation of a strong patient-provider relationship with self-management support tailored to the patient’s unique needs. There is a focus on behavior change, an active lifestyle, and a positive attitude.
MedRisk is in alignment with these recommendations and helps facilitate a person-centered approach for patients through consultation with an on-staff PT in advance of treatment and in cases of interrupted recovery. Self-management is also a primary goal for treatment in the MedRisk Telerehabilitation Program.
Hutting, N., Johnston, V., Staal, J. B., & Heerkens, Y. F. (2019). Promoting the use of self-management strategies for people with persistent musculoskeletal disorders: the role of physical therapists. journal of orthopaedic & sports physical therapy, 49(4), 212-215.
Sep 14, 2020 | Insights
Research has shown broadly that early PT can improve outcomes and reduce utilization of other medical services. WCRI’s new study examines how this plays out in workers’ comp cases.
Physical therapy (PT) has become a widely accepted and critical conservative care recommendation for low back pain (LBP) in the last decade, reducing the need for other, more invasive procedures and opioid prescriptions. As such, the timing of PT has become the subject of a number of studies which have proven early is better. Early treatment improves outcomes and reduces the utilization of other medical services.
Building on this research, the highly respected Workers’ Compensation Research Institute (WCRI) has conducted the most comprehensive study addressing PT timing focused on workers’ compensation patients. One of the researchers, Dr. Kathryn Mueller, is a member of MedRisk’s International Scientific Advisory Board.
Here are the study details, key findings and critical takeaways for the workers’ comp industry.
Study Details
The study looked at how different timing of PT may impact:
- The utilization of MRIs, opioid prescriptions, pain management injections, and lumbar surgeries
- Total medical costs per claim (not just PT)
- How many weeks of temporary disability benefits are used per claim
Vague terms like “early” and “late” have been interpreted any number of ways in existing research. In this study, WCRI examined the outcomes of five PT-timing groups (within 3 days, 4-7 days, 8-14, 15-30 and more than 30-days post injury) and defined “late PT” as more than 14 days of injury.
Key Findings
Patients who received early PT (within three days of injury) were:
- 46% less likely to receive opioid prescriptions
- 47% less likely to receive an MRI
- 29% less likely to receive pain management injections
- Less likely to involve an attorney in the claim (14% average involvement) than those who received late PT
Patients who received late PT (more than 30 days after injury):
- Were on temporary disability that lasted 58% longer
- Were 89% more likely to have low back surgery
- Had an average attorney involvement of 27%
It is important to note that even “late” PT can still improve outcomes over no PT at all. Across all claimants, and regardless of timing, fewer than 5% had back surgery.
Critical Takeaways
This cornerstone study clearly supports the value of including PT as a first-line treatment option and removing barriers to early PT.
While the researchers say further study is needed, the findings that early PT is “likely to be beneficially associated with a lower utilization of medical services, lower overall medical costs, and shorter temporary disability” is critical validation of the importance of physical medicine in treating injured workers.
So what can make a positive impact on workers’ comp claims? Experience shows that rapid scheduling, patient advocacy, clinical guidance that supports conservative care first, integrated technology, and a management program that connects patients with the right PT quickly have a significant impact on outcomes and cost.
