In past posts we discussed the value Physical Therapy can bring when utilized early and the benefits of finding the most highly trained therapists to deliver the most evidence based, effective treatment. Unfortunately in Workers’ Compensation there can be limited access to early Physical Therapy as most states require a Physician order for Physical Therapy. And if an order is not required most carriers will not pay for PT in Workers’ Comp without a physician order.
Some employers have started to become proactive and offer their workers complaining of musculoskeletal issues early access to a Physical Therapist as part of a triage or first aid program. But success in these programs is often limited as treatment is limited to “First Aid” to avoid OSHA recordability concerns.
Why is their an access issue to Physical Therapy for Workers Compensation claims? Direct access for non-workers’’ comp musculoskeletal issues has been successful in delivering cost effective solutions and early access without increasing risk. Physical Therapists are now receiving the medical screening training to triage patients that have red or yellow flags and refer to the appropriate medical expert when PT is not warranted or contraindicated.
A study by Childs et al in 2005 in BMC Musculoskeltal Disorders,demonstrated that Physical Therapists (even DPT level students) demonstrated higher levels of knowledge of managing musculoskeletal conditions as compared to all physician specialties with the exception of orthopedists.
The landmark 2006 Virginia Mason study demonstrated significant cost savings when utilizing Physical Therapy first for low back pain versus the traditional “medical maze” of physician visit, diagnostic imaging, follow up physician visit and then potentially Physical Therapy. The study was basically the result of a couple of employers getting actively involved in managing their musculoskeletal costs. This makes sense for self insured employers. Why not deliver the most cost effective treatment for our injured workers while avoiding unnecessary visits and procedures?
Putting a Physical Therapist first in a Workers’ Compensation claim obviously would create a disruption that would require strict oversight policies and training in the PT community. Many Physical Therapists would not be comfortable serving as the gatekeeper in the often litigious and contentious world of Workers’ Compensation. One solution could be the development of Occupational Medicine Specialty in Physical Therapist practice by the APTA, These providers could serve as an option for initial encounters for workers with musculoskeletal complaints. In addition more research will need to be done to test the efficacy of such a model.
There has been one study that demonstrated cost savings when using a Physical Therapy first model for injured workers. A group of Physical Therapists (Ojha, et al) looked at the cost efficiency of using Direct Access Physical Therapy for injured workers at Temple University in a 2015 study in Orthopedic Physical Therapy Practice. The study demonstrated low episodic costs and positive outcomes for patients receiving PT first. Although the study was small and contained a largely homogenous population; the researchers developed some nice screening protocols and treatment algorithms that could be used in further studies investigating direct access in workers’ compensation cases.
As we continuously look for better ways to deliver cost effective care in Worker’s Compensation, we need to continue to think of ways to disrupt the long accepted procedures for handling musculoskeletal disorders. Knowing that research has demonstrated a small number of these patients ever need diagnostic imaging, opioids or surgery; we should begin to discuss solutions that can get these patients in the hands of Physical Therapy providers as soon as possible.
