The mass shift to remote working (and even permanent telecommuting) has interesting implications on workers’ compensation class codes.
Prior to the pandemic, only 6 percent of U.S. workers worked from home – and 75 percent had never worked from home before. This all changed in May 2020 when more than 33 percent of workers started remote working.
Now, the data is in. Two recent reports from the National Council on Compensation Insurance (NCCI) show interesting trends in class codes as a result of this shift to remote work.
- Workers’ compensation class codes with higher telecommuting potential tend to have lower loss costs than others
- The office and clerical group has lower average loss costs
- Loss costs in the office and clerical group account for nearly 60% payroll exposure but just 11% of premium
While there may be a shift among classifications in the months to come, other issues come to light. The move to ergonomically incorrect home offices could cause more repetitive stress injuries and slips and falls.
MedRisk is committed to keeping a pulse on class codes and trends in workers’ compensation to help adjusters, case managers and providers efficiently and effectively care for workers.
Read more about the shift in class codes from NCCI here.
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.
For patients with a new episode of neck pain, initially consulting with a nonpharmacological provider (physical therapist or chiropractor) may decrease opioid exposure.
Neck pain is an immense physical, social and economic burden, regarded as a major public health problem. In fact, half of all individuals will experience a clinically important episode of neck pain at some point in their life, and 80% of those people eventually seek care. Despite this prevalence, there has been no consensus on the type of provider a patient should see first for care—a key indicator of downstream healthcare utilization. On top of that, there are the ever-present dangers of opioid addiction, which has been identified as a public health epidemic.
To address these problems, a study published in the Mayo Clinic Proceedings: Innovations, Quality & Outcomes journal aimed to determine the connection between the type of provider initially consulted and 1-year, downstream healthcare utilization to inform future care recommendations.
In the study, Horn et al investigated a retrospective cohort of 1,702 patients with a new episode of neck pain over a 1-year period. The researchers then separated those patients into groups based on who they consulted first: primary care provider (PCP), physical therapist (PT), chiropractor (DC), or a specialist.
The study found that the practitioner consulted at the index visit for neck pain can have an impact on downstream healthcare utilization. More importantly, the researchers found that, when compared to an initial neck pain consultation with a PCP, an initial consultation with a nonpharmacological provider (DC or PT) is associated with a decrease in opioid use 30 days and 1 year after initial consultation.
These findings are consistent with recent guidelines, which favor nonpharmacological interventions. In light of the opioid addiction epidemic, stronger alignment of PTs and DCs as front-line providers by healthcare systems may be needed.
MedRisk’s PTConsult services support this goal by proactively identifying and solving for issues through a telephone consultation and screening process. PTConsult takes or recommends the best course of action to eliminate obstacles to recovery and reduce total claim cost and healthcare utilization.
To read the full article, click here.
Horn ME, George SZ, and Fritz JM – Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain
Mayo Clin Proc Innov Qual Outcomes. 2017 Dec; 1(3): 226–233.
Physical therapists can empower patients with chronic musculoskeletal disorders by supporting effective self-management.
Persistent musculoskeletal disorders—including spine-related neck and back problems—are painful to patients and costly for workers’ compensation payers and society as a whole. Among occupationally active adults, musculoskeletal disorders are the main causes of disability. Often work related, they can lead to lost time and reduced productivity.
Biomechanical and psychosocial risk factors often influence musculoskeletal disorders. That’s why, as an article published in the Journal of Orthopaedic & Sports Physical Therapy argues, a person-centered approach focusing on self-management strategies is so essential to helping patients restore and maintain function.
In the paper, Barlow et al outline the physical therapist’s (PT) role in supporting effective self-management. The authors define self-management as “the ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition.”
As experts in musculoskeletal disorders, PTs are ideally positioned to provide self-management support that focuses on teaching skills that patients can use to manage these conditions on their own. In this approach, PTs help patients understand their conditions and the biomechanics of them while promoting behavioral changes and active lifestyles.
PTs help patients develop a patient-preferred approach to physical therapy exercises to improve function and strength, reduce pain, and increase well-being. The goal is for the patients to develop their own strategies to reducing their symptoms. Techniques may involve exercise, pain management, cognitive behavioral therapy, shared decision-making, acceptance, problem-solving and/or mindfulness, and other techniques. It’s all very individualized.
With self-management, PTs provide support as the patients set goals, recognize barriers to achieving them and learn how to measure the effectiveness of their own self-management. This provider-patient partnership is an essential component of this approach.
As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk stays abreast of industry trends such as this. By so doing, we continue providing our carriers, TPAs and employers access to the best national network of credentialed PTs in the workers’ compensation industry.
To read the full article, click here.
Promoting the Use of Self-management Strategies for People with Persistent Musculoskeletal Disorders: The Role of Physical Therapists
Nathan Hutting, Vernerian Johnston, J. Bart Steal, and Yvonne F. Hearkens
Journal of Orthopaedic & Sports Physical Therapy 2019 49:4, 212-215
Adherence to established clinical practice guidelines could reduce high downstream healthcare utilization.
Musculoskeletal pain as a whole is a common and costly health condition. Up to 84% of the general population will report at least one episode of low back pain (LBP) at some point in their life. This high rate of LBP treatment also has high downstream costs. An article published in PLOS One systematically reviews a collection of peer reviewed studies to evaluate the influence of physical therapy guideline adherence on healthcare utilization and costs for LBP patients.
Hanney et al conducted an electronic search across various peer-reviewed journals to assess current evidence on how guideline adherence affects LBP costs. The authors identified seven primary factors for healthcare utilization and costs:
- Number and duration of PT visits
- Prescription medication use
- Physician office visits
- Emergency department care
- Advanced imaging
- Surgical procedures
- Injection procedures
With some exceptions, the review showed that those participating in an adherent PT treatment program experience lower healthcare utilization. This includes fewer and shorter PT visits, fewer medications, fewer visits to the physicians or emergency department and less use of advanced imaging, surgical, and injection procedures.
While further research is needed to provide firm evidence on the impact of guideline adherence among patients with LBP, this preliminary evidence is a great step towards optimized effectiveness and efficiency in value-based healthcare systems.
That’s why MedRisk invested in the development and on-going maintenance of physical medicine specific evidence-based treatment guidelines. These guidelines take into consideration chronicity (the age of the injury), complexity (multiple body parts and/or comorbidities), severity and surgery. They also address the best treatment choice, timing, and sequence of interventions. Their specificity make them a valuable supplement to ODG, ACOEM, and state-specific guidelines. MedRisk’s proprietary guidelines, developed and maintained by our International Scientific Advisory Board, allow us to proactively identify cases that may be trending off track and support clinical decision-making—ultimately eliminating unnecessary downstream utilization and costs.
To read the full article, click here.
Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature. PLoS One. 2016 Jun 10;11(6):e0156799. doi: 10.1371/journal.pone.0156799. PMID: 27285608; PMCID: PMC4902217.