As many who work in the realm of Workers’ Compensation understand, physical therapy has become a commodity – with referral business often going to the provider who can offer therapy visits at the lowest cost. But what influence does this have on Workers’ Compensation claims?
A paper published by PTPN in May 2016 outlined the impact of physical therapy on total medical and indemnity costs and the results outlined why choosing the lowest-cost physical therapy provider can significantly drive up the cost of a workers’ compensation claim. But how can that be? The answer lies in the quality of care provided by these discount providers.
The PTPN article outlines that quality matters to ensure improved outcomes and reduce overall costs. Quality therapy may cost payers more on a per-visit basis, but the end result should justify the means. Unfortunately, despite mounting evidence, many employers and carriers still choose their therapy provider based solely on cost per visit. It is worth asking though, how are some therapy providers capable of discounting their rates so much as to undercut other therapy providers? Are they paying their therapists less? Not likely in this job market. Are their operating expenses less? Not probable.
So what else can these providers discount to offset their reduced rate while still maintaining some level of profitability? These providers save on costs by using non-licensed aides to administer care, limit 1-on-1 care, avoid investments in reporting tools to track the quality of their outcomes, and provide little continuing education benefits to their therapists. All of these cost-saving measures lead to lower quality care, poorer functional outcomes, low patient satisfaction, and ultimately, higher total costs of care. PTPN claims their research demonstrates that physical therapy providers with the best functional outcomes save payers on average 30% in physical therapy costs. That’s significant and far outweighs the investment of sending injured workers to quality therapy providers.
We’ve just established that quality matters when selecting a therapy provider. Quality care, while perhaps more expensive on a per-visit basis, ultimately enhances the injured worker’s experience and saves payers money across the duration of the claim. So what else can be done to improve outcomes and reduce costs? In addition to high quality care, the PTPN article also discusses the importance of getting patients into physical therapy early.
The article cites the landmark 2012 Spine1 study which demonstrated that getting patients into physical therapy within the first 14 days of a low back injury resulted in a total cost of care savings of $2,736.23 per case.
This emphasis on early access can be particularly important in Workers’ Compensation, where at times, there can be a “wait and see” approach regarding referral to physical therapy. While the intent of avoiding the cost of physical therapy (and at times OSHA recordability) may be well intended, it often backfires, increasing costs when compared to groups who receive physical therapy as soon as possible. While physical therapy costs often make up a relatively small percentage of a Workers’ Compensation claim, delaying physical therapy has been shown to contribute to increased utilization of much more expensive medical services. The 2012 Spine study found that early physical therapy cut the need for advanced imaging from 54.9% to 29.4%, additional physician visits from 81.0% to 52.6%, lumbar spine surgery from 9.9% to 4.7%, lumbar spine injections from 21.2% to 10.1% and opioid use from 55.3% to 49.1%. Considering that many of the items on the prior list are very expensive and/or invasive, physicians and payers should be focused on early referral to therapy to promote better outcomes and reduce risk.
Don’t want to rely on a single study’s findings on how important it is for injured workers to receive early access to physical therapy? How about referencing ODG? ODG’s Treatment Planning resource outlines consideration of referral to physical therapy within a week of the initial physician visit (referencing low back treatment plans). These evidence-based guidelines also advise plans of care at 3x/week with an emphasis on active interventions. As you can see, early access to physical therapy is crucial to facilitating improved outcomes.
Employers and Carriers should look for high quality physical therapy providers versus those that can simply provide a visit for the lowest cost. Look for physical therapy providers with the highest level of training in evidence-based practice and can demonstrate their functional outcomes on risk adjusted, benchmarked registries. In addition, they should look for providers that utilize “hands on care” in a 1 on 1 environment; with care directed by a physical therapist. They should also look for medical providers with less of a “wait and see” approach to therapy, instead focusing on providers that have a good understanding of the indications for, and the appropriate timing of, a physical therapy referral. These practices may appear to be cost drivers, but as we’ve mentioned above, there is evidence demonstrating the opposite effect.
Caution should be used when a physical therapy practice or other entity markets their cost per visit as a source of value. The question for carries and employers should be: What are my employees getting for this reduced cost? What are the functional outcomes for injured workers seen by these discount providers? If no improvements in functional outcomes are demonstrated, it doesn’t matter what the visit costs. Ultimately, no cost savings are created if the patient is unable to return to work, needs additional expensive medical services, or if the claim isn’t closed in a timely fashion.
In the Workers’ Compensation arena, we need to move beyond the assumption that the quality of all physical therapy is the same and that it should be used sparingly or with extreme caution. Carriers and employers need to take a more active role to ensure their patients receive the right physical therapy, at the right time. When applied appropriately, physical therapy can be a powerful cost saving service. In addition to the savings created, it also the right way to treat the injured worker to ensure optimal outcomes are achieved.