In healthcare, we need to know what produces the best outcomes with a mindfulness of the cost of care for both the patient, provider, and insurer. There needs to be a clearer understanding of what drives cost and where to spend our money to prevent longer-term expenses. Physical therapy in workers’ compensation cases is one example of where there is often a lack of clear understanding of what can be done to produce positive outcomes with these cost drivers in mind.
One can easily assume if patients are getting injections, having surgery, and being given opioids, they are likely to have prolonged cases and be either out of work or on limited duty for longer periods of time. There has been evidence that states this is exactly the case.
I have encountered numerous employers, physicians, case managers, and carriers in my years of practice that view physical therapy solely as a cost driver in Workers’ Compensation. It is a modality that needs to be done to appease the patient at some point along the course of care while we hope they get better or settle their case sooner. Oftentimes this attitude creates a “wait and see” approach with physical therapy, while the bills from medications, diagnostics, and lost time continue to accrue.
“I know your back pain is a 10/10, here are some meds. Come back and see me in a week after some light duty. Hopefully it calms down. We will see how you feel.” Unfortunately, this has been a common approach when treating workers’ compensation patients.
There has been a stigma placed on getting patients into physical therapy right away. Some of this hesitance has been fueled, and sometimes rightfully so, by providers with in-house physical therapy where the view is physical therapy is overutilized. To the contrary, the research shows that taking a pragmatic approach to physical therapy and introducing it early in a workers’ compensation case can significantly reduce medical costs and indemnities.
Physical therapy allows the ability to remain physically active while addressing the pain and without the risk that opioids present. The Mental Health Clinician published an article in July 2020 that states just this idea, early physical therapy not only improved disability but decreased pain and in turn reduces the need for medication.
Physical therapy not only addresses the pain but assists with return to activity and addresses injury prevention through education, all of which help with addressing the psychosocial effects of the injury on the patient.
As has been discussed in previous posts, there is a study that demonstrated a significant decrease in the use of imaging, spinal injections, spine surgery, physician visits, and opioid use when physical therapy was introduced in the first 14 days following a lumbar injury.
A study in Archives of Physical Medicine and Rehabilitation has similar findings, those that receive early physical therapy when suffering from back pain have better outcomes than those that wait. This cost-saving alone averaged $2,736 per patient, which is just the tip of the iceberg. It has been reported that up to 2/3 of the cost of a Workers’ Compensation case comes from indemnity costs.
A 1996 Physical Therapy study by Erhmann-Feldman et al demonstrated that patients receiving physical therapy had an earlier return to work than those that did not. Hagen et al demonstrated in a 2000 Spine study that a higher percentage of patients returned to full duty more quickly from a long-term sick leave for low back pain when they received physical therapy early versus waiting.
Physical therapy is an expense in a workers’ compensation case which cannot be denied.
However, it is important to understand that finding high-quality therapy programs and applying them as early as possible in the case can significantly reduce the total cost of a claim and get our patients back to work sooner. Waiting to begin physical therapy until after our injured workers have already started receiving additional, often unnecessary services can be throwing good money after bad. Once we have applied the “wait and see” approach to physical therapy, controlling the cost of the claim becomes a much more difficult endeavor.