With the nation spending billions on medical and indemnity expenses for employees injured on the job, as well as patients facing illnesses or surgeries, workers’ compensation carriers, group health insurers and third party administrators (TPAs) are looking for innovative solutions to providing better and less costly health services.
Two Thought Leadership papers — one for workers’ compensation payers and one for group health organizations — from PTPN, the nation’s first network for independent rehabilitation specialists, examine the role and benefits of physical therapy in both group health and workers’ compensation cases in the face of major changes in the American healthcare system.
“As they adapt to new value-based care models, health plans and workers’ comp carriers require new solutions to meet their needs and those of injured workers,” says Michael Weinper, PT, DPT, M.P.H., president of PTPN. “These papers show how a different approach to the changes in the nation’s workers’ comp and group healthcare can not only improve the delivery of health services, but also deliver better outcomes for a wide range of patients at a lower cost.”
According to The New Paradigm for Better Quality, Lower Costs papers — Leveraging the Power of PT for Workers’ Comp and Leveraging the Power of Ancillary Services — workers’ comp carriers and health plans and may be missing an important ally in their efforts to meet the goals of healthcare delivery today: providers of physical therapy services. Studies show that bringing physical therapy into an injured patient’s treatment early can have major benefits, including better patient outcomes, reduced use of pain medicine, improved patient satisfaction, reduced readmissions and lower medical and indemnity costs.
Key points to consider from the PTPN papers include:
While imaging often is used to diagnose patients with chronic and or acute back pain, it may not be the best first step. A 2015 study in Health Services Research Journal found that for patients who were first treated with physical therapy, costs were an average of $4,793 less than patients first sent to imaging.
A landmark 2012 study in Spine reported that prompt referral of patients from primary care physicians to physical therapy resulted in decreased use of advanced imaging, surgery, injections and prescription pain medications. Savings were an average $2,736.23 less for patients receiving early physical therapy.
The Workers’ Comp Research Institute reports that 65% to 85% of injured workers getting a pain medication are prescribed an opioid. Industry analysis of best practice data indicates that close to 90% of those injuries are more appropriately treated with over-the-counter pain medications and PT. Avoiding opioids can reduce the possibility of reliance or even addiction to the powerful drugs, a concern in the United States today.
According to the American Hospital Association, organizations should seek to develop “preferred relationships with post-acute providers that have demonstrated good outcomes and are willing to collaborate on performance improvement.” The PTPN papers offer steps to finding PT providers who meet these criteria, as well as what to expect from a quality independent PT network. These benchmarks include innovation in care pathways and readmission risk reduction; the highest credentialing and quality standards; and outcomes measurement.
“By collaborating with independent physical therapists who hold themselves to the highest standards of care,” says Weinper, “health plans and workers’ comp carriers can achieve the vision and promise of today’s value-based healthcare programs.”
About PTPN: PTPN is the nation’s premier specialty network of rehabilitation therapists in independent practice. It has led the rehabilitation industry since 1985, pioneering innovative payer contracting, quality assurance, outcomes measurement and pay-for-outcomes (P4O) programs. The network comprises hundreds of therapy office locations and thousands of physical, occupational and speech therapists across the country. PTPN contracts with most major managed care organizations in the nation including insurers, workers’ compensation companies, PPOs, HMOs, medical groups, and IPAs. All members of PTPN must be independent practitioners who own their own practices. For more information on PTPN, contact Stephen Moore at 818-737-0246 or firstname.lastname@example.org, or visit ptpn.com.