3 weeks ago
Collaboration: The Key to Successful PT Claim Outcomes
Facilitating treatment doesn’t happen in a vacuum. There are many steps throughout the PT claims process, and in order for it to run efficiently, there must be trusted partnerships, open communication, and above all, collaboration, amongst all parties – provider, physician, payer and care coordinator.
Physical therapy is one of the most common types of treatment needed following a workplace injury. In fact, 62 percent of claims include outpatient physical medicine services.1 Collaboration plays an important role in successfully moving these claims forward and supporting the injured worker throughout their recovery journey.
During a recent panel discussion, industry stakeholders had the opportunity to share personal insights as to how collaboration positively impacts different aspects of the claims process. Tune in to their engaging discussion and read on to discover the key themes that rose to the top:
Collaboration: The Key to Successful PT Claim Outcomes
Removing Barriers to Care
There are many external factors that can impact an injured worker’s recovery process, making it vital to create a strong program inclusive of clinical oversight, an expansive network of quality providers, and a unified patient-centric approach to care.
Injured workers can sometimes be the greatest barriers to their own recovery. Some of their behaviors can inhibit progress, such as displaying hesitation about recovery; creating physical barriers or being fearful that therapy will be too strenuous and painful. In these moments, collaboration can make all the difference by surrounding the injured worker with support and compassion, encouraging them to focus on activities they enjoy and want to return to, and providing them with consistent messaging so they trust and believe in their course of treatment.
Addressing a workplace injury quickly can have the greatest impact on the life of a claim. Muscle atrophy can begin as early as 48 hours following an injury, demonstrating the importance of early engagement. We have found that injured workers who start physical therapy within three days of injury require 38 percent fewer PT visits to achieve successful outcomes.2 Through an established collaborative care approach, key stakeholders can work together to create a customized course of treatment and begin to facilitate care. By introducing PT early, it creates a ripple effect – reducing the need for surgery, reducing the likelihood of opioid-use to manage pain, and ultimately, gets the injured worker back to work and life sooner.
Clinical oversight aligns key stakeholders prior to the start of care and throughout the injured worker’s recovery. When clinical oversight is incorporated, the claim is closely monitored, and intervention is taken if the injured worker begins to veer from their recovery path. This approach utilizes evidence-based guidelines to establish expected therapy utilization and recovery times, thus mitigating unnecessary and excessive care.
Clinical oversight has led to impressive results for injured workers. When incorporated, we have found that upon discharge, more than 90 percent of injured workers have minimal to no pain, more than 85 percent have functional range of motion, and the average therapy utilization is 30 percent below ODG guidelines.3
Data & Treatment Planning
Data is an important element within the claims process, helping to tell the story of an injured worker’s unique recovery journey. Statistical evidence enables stakeholders to identify risk factors for poor recovery, analyze treatment options and outcomes, anticipate costs and duration timeframes, and develop personalized care plans.
For an injured worker, the recovery process can induce emotional and mental stress, outside of their physical injury. When a physician meets with an injured worker to discuss their course of treatment, data can be shared to compare one course of care over another, giving the injured worker a better understanding of their treatment so they can take a more active role in their recovery.
Importance of Coordinated Care
Care coordination is the deliberate, orchestrated and timely delivery of patient care across multiple services in order to deliver high-quality outcomes. A recent study showed that a coordinated care approach can improve an injured worker’s health outcomes and reduce medical costs by 31-55 percent. Care coordinators play an integral role throughout a collaborative claim process.4
Defining a ‘Good Outcome’
The definition of a ‘good outcome’ can vary based on the stakeholder’s role or function, but at its core, a good outcome can be defined as an injured worker regaining the best possible function so they can return to work and life. In order to achieve good outcomes, it’s important to encourage the injured worker to focus on their progression rather than their level of pain. By focusing on function, the physician and therapist can better evaluate how an injured worker is recovering and modify treatment to meet the desired outcomes.
In the words of Henry Ford, “Coming together is a beginning, staying together is progress, and working together is success.” When true alignment occurs amongst all key stakeholders, the injured worker wins. Click here to learn more about One Call’s collaborative physical therapy program or complete the following form and a member of our team will contact you.
Monnin-Browder, W. & Yang, R. (2020). CompScopeTM Medical Benchmarks for California (21st ed., pp. 81). Workers Compensation Research Institute.
One Call national data. Reflects injured workers with shoulder injuries who completed physical therapy from Jan 2018-July 2019. Data excludes injured workers who received surgery prior to starting therapy.
One Call national data.
One Call. (2020, December). Coordinated Care: The Payoff is Real. https://onecallcm.com/about/news-blog/coordinated-care-the-payoff-is-real