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Physical therapy costs can be one of the top medical expenses in the early stages of a workers compensation claim. But such costs can be controlled with utilization management to help physical therapists perform only necessary treatments.
Mike Farrand, Radnor, Pa.-based national technical director for workers comp medical cost containment at Willis Group Holdings P.L.C., said physical therapy costs can account for up to 50% of comp costs in the first 90 to 120 days of a claim.
Experts say physical therapy costs can accumulate quickly because they occur in the acute phase of an injured worker's recovery and include bills that are relatively cheap, but accumulate over time.
“It's seen to a lot of groups as a small incremental cost,” said Ian McDaniels, Indianapolis-based vice president of directed care solutions for CorVel Corp., a provider of medical cost containment and managed care services. “It's just a visit here or a visit there. Well, those visits add up.”
Additionally, physical therapists sometimes try to make up for the low cost of services they provide by billing for several treatments during each patient visit, Mr. McDaniels said.
“A lot of patients go into therapy and think they're going to go get a massage,” Mr. McDaniels said. “And though a massage would probably feel very good, it's not what they need.”
Mark Walls, St. Louis-based senior vice president and workers compensation market research leader at Marsh Inc., said treating physicians often prescribe more physical therapy than a patient needs because they're uncertain how long a patient's recovery will take.
“There's a lot of physicians that just write a prescription for physical therapy that says "evaluate and treat,'” Mr. Walls said. “They'll leave it open and let the therapist dictate” the treatment duration.
The key to keeping physical therapy costs down is to conduct regular reviews of a patient's treatment and end physical therapy sessions once it's clear that a patient has received the maximum benefit from treatment, sources say.
“If they are making progress, then you keep doing it,” Mr. Walls said. “When they plateau, you stop.”
Medical treatment guidelines can provide a framework for how many physical therapy sessions a patient needs. But insurers and employers should talk weekly with physical therapists to determine how long therapy should continue, Mr. McDaniels said.
Such discussions ideally should be led by people who have practiced physical therapy and can evaluate a patient's progress, Mr. McDaniels said.
While utilization management can result in fewer physical therapy visits, it can also lead to ongoing care if it's determined that continued therapy would help the worker avoid reinjury, Mr. McDaniels said.
“We will fight for more care when appropriate, just as much as we will fight with that therapist to say "show us why you need more treatment,'” Mr. McDaniels said.
In addition to utilization management, Willis' Mr. Farrand says employers should consider using physical therapy specialty networks, which provide physical therapy at a discounted cost.
Marsh's Mr. Walls said physical therapy sessions should focus on using active modalities that strengthen patients rather than passive modalities that only provide pain relief. He also recommends that physical therapists provide patients with home exercises that can be performed without billing for another physical therapy session.
While such steps can reduce the direct cost of physical therapy claims, Mr. Farrand said utilization management can lead to larger savings down the road for employers.