The Futureof Industrial Physical Therapy
As markets shift, many practices consider developing a stronger focus on occupational injuries.
By Dan Mills, PT
Nearly every work setting imaginable has benefitted from mechanization. Engineers have changed most aspects of our work for the positive. Design engineers are held up as artists in their ability to balance form and function to artistic proportions. Every interface of every device and piece of equipment has been examined to optimize its most efficient completion of its task. In many cases, the human component has been completely eliminated from work.
Despite these advances, many fields continue to require a human interface, and employees continue to experience injuries. In most cases, the number of injuries has dropped significantly with mechanization; however, the nature of these injuries has changed, and often the severity has increased. Add to this fact the challenges of an aging workforce and the deconditioning of the general population as factors in the increases in severity and frequency. Despite technological innovations, exposure in the workplace continues.
Mechanization has led to unique and sometimes obscure muscle groups taking more prominent roles in certain tasks, requiring a physical therapist to be more adept at accurately diagnosing based on history, mechanism of injury, knowledge of anatomy, and physical exam. An observant physical therapist will note that though the mechanism has changed, workplace exposures to heavy weights, awkward positions, and repetitive motion is still with us. Physical therapists will continue to be providers of choice in treating and preventing these exposures.
Perceived increase in severityCases that cost less than $10,000 make up 65 percent of the workers compensation payouts.1 These include a large number of musculoskeletal injuries treated in physical therapy clinics conservatively with full return to work and no lost time. Catastrophic injuries, including severe brain injuries, spinal cord injuries, and even death continue as a cost but make up a decreasing percentage of the number of cases.
The cases that draw the most attention of payers, as well as companies, are the cases in between. Let’s examine two hypothetical knee patients with a similar knee injury from the insurance company’s perspective: one incurs under $10,000 in total costs including physical therapy and medical doctor visits, anti-inflammatories, and light duty restrictions. The other case incurs more than $50,000 in total costs including lost time, a perceived unnecessary surgery, a cash settlement, litigation costs, and job placement. As physical therapists, we understand the complex variables that might lead to this disparity.
Savvy ConsumersIn a typical outpatient clinic, we consider our patients as consumers. I would add the employer and their insurance company as consumers of physical therapy as well. In reality, they are paying for the service we provide, and therefore are judging the return on their investment. This measurement at its most base level is the cost of accepting a claim versus denying it and dealing with the downstream litigation costs.
Employers have developed a more nuanced understanding of what we do. In many cases, they are hoping you will provide solutions that decrease long-term costs, rather than simply continuing to reap benefits from their losses. This is a difficult pill to swallow for many physical therapists because it requires potentially working yourself out of a job in providing more prevention and less downstream care.
Understanding the amount of energy that employers and their insurers devote to limiting this exposure is instructive. If we as physical therapists can control some of these costs while still providing excellent care, we can change the perception of payers that physical therapy is simply another cost to be managed as aggressively as possible.
Current and Future Models of CareThe key to success in most workers compensation markets is understanding the needs of the employer, justifying your expense as a means of decreasing their costs, and providing treatment in a cost-effective manner—especially as it relates to physical therapy.
Physical therapists may choose to take the service to the workplace. This decision must be considered carefully. Physical therapists who have been successful with this model, partner with committed large employers, with a reasonable number of physical therapy patients—often in areas where care is not accessible for employees. The exception may be forward-thinking employers that hybridize the physical therapy clinic to treat industrial as well as nonindustrial injuries. In any case, the personnel costs, including travel and potential downtime, should be carefully considered.
The brick-and-mortar location of a clinic has become increasingly significant. Employers are sensitive to travel time and costs when their employees go offsite. They may often choose a clinic that is located geographically closer to the medical clinic and/or drug testing operation they prefer. The proliferation of national entities that attempt to provide one-stop-shopping industrial care is both an opportunity and a threat. In my experience, locally owned companies typically prefer local partners for treating industrial injuries— if you can show the same level of expertise and a higher level of customization. Similarly, national companies are sometimes willing to forego a national contract in favor of a local provider if that provider can differentiate themselves.
A vast array of prevention services can be offered including: ergonomic assessments, pre-employment post-offer testing, exercise programs, health monitoring, education programs, workstation evaluations, and case management. Our understanding of musculoskeletal injuries and basic physics allows us to provide a unique perspective on some of the most expensive problems in business. A wide variety of continuing education and online resources are available through PPS vendors, as well as the Orthopedic Section’s Occupational Medicine Special Interest Group. Beyond these, consider attending conferences designed for Human Resources and Safety Professionals to learn what is known and not known by these consumers you are trying to reach.
The future of industrial medicine will require a provider who is committed to a deep and broad understanding of the specific company’s work and a general understanding of the rules and guidelines related to occupational injuries in your state. Physical therapists who take the time and do the appropriate analyses may find untapped opportunities that may provide a source of stable long-term financial relationships.
Dan Mills, PT, is a PPS vice president and owner of Performance Rehab Clinics. He can be reached at email@example.com.
1. Liberty Mutual www.libertymutual.com. Accessed November 2014.