I recently attended an event for the Chicago chapter of the Disability Management Employer Coalition. The topic was tackling physical therapy/occupational therapy over-utilization, a national problem for employers, claims adjusters and case managers who handle workers’ compensation cases.
Most of the talk was geared toward case managers, but the employer takeaway I got was that self-insured companies end up paying for therapy that’s not necessarily helping injured employees return to work faster. Sometimes when PT isn’t getting the job done, a doctor, for whatever reason, will recommend more PT rather than an alternative treatment. Overutilization is a huge cost driver for companies. There should be a “next step” in case therapy is not working and the patient is not progressing, argued the speaker, workers’ comp expert Cindy G. Rega.
The Chicago chapter members had a lot of questions about their own personal experiences trying to deal with situations like this, when an injured worker is attending therapy but not getting desired results. These experiences were mostly from that case manager perspective. Still, the gist was: the longer these workers are injured and doing PT/OT that is not getting the job done, the longer the employer is out of an employee.
Hearing these experiences made me realize how prevalent this is and how frustrating working through the process can be.
To help me understand more deeply what employers should know about PT/OT over-utilization, LaVina Branch, president of the DMEC Chicago Chapter, gave me the rundown for employers. Branch is also the manager of workers’ comp and leave management at McMaster-Carr Supply Co. in Elmhurst, Illinois.
The employer-employee relationship puts the employer in the position to guide and empower employees, said Branch. Employers hear the complaints employees have when an injury isn’t getting better. They can ask the injured person questions like, have you talked to your doctor about the type of therapy you’re receiving? Do you think that’s working? Should they try something different? Have you talked to your therapist about this?
“You have to help your employee understand they need to be an advocate for their care,” she said. “Just because it’s a work injury doesn’t mean you’re not an advocate for your care. Just like you would advocate if it were a personal illness or injury, you have to do the same if it’s work related. It’s still your body.”
Another major employer takeaway was to be aware that over-utilization happens. And also be aware that other parties involved, like claims adjusters, might not be looking at this closely. That’s why the employers should take it on to empower employees to become a larger player in their own care.
“If they’re going to therapy that is not improving them, then something else might be wrong,” Branch said. “There might be a need to peel back the onion and dig deeper.”
This could go on for months, she added. Instead of letting that happen and having to be reactive, be proactive. Set up a calendar, and if the employee doesn’t get better by a certain time, take another step, like talking to the doctor, to find out if treatment plan is working.
Andie Burjek is a Workforce associate editor. Comment below, or email at aburjek@humancapitalmedia.com. Follow Workforce on Twitter at @workforcenews.
“The topic was tackling physical therapy/occupational therapy over-utilization, a national problem for employers, claims adjusters and case managers who handle workers’ compensation case” Is there really data to support this?
Healthcare trends show a growing self- insured market which makes employers motivated to reduce HC costs. Employers need to do more in the prevention arena and physical therapy can play a huge role in wellness not just the care after an injury. Prevention through risk reduction can reduce the frequency of health problems and associated costs. These big picture issues need to become the focus of our interventions to keep people healthy. Rather than just address a problem when it arises, addressing risk factors that are either on the causal pathway to disease, or strongly associated with disease, provides the opportunity to get upstream of disabling and costly health problems.
So employers would prefer to pay for surgery or a lifetime of pain meds, rather than some additional PT or OT?