By PETER ROUSMANIERE, an expert on the workers' compensation industry
Workers who sustain a musculoskeletal setback at work often need clinicians to help them restore their physical functioning. In Texas, according to a recent survey, some one-third of injured workers receive some form of physical medicine treatment, which includes physical therapy, occupational therapy and chiropractic care.
It should be no surprise then that managed care in workers' compensation has focused on physical therapy, which is referred by doctors in the initial course of treatment, often as a follow-up to surgery. Thousands of physical therapy clinics, staffed by individuals with a wide range of professional training and under widely varying models of ownership, create a classic opportunity for the application of managed-care ideas about best practice.
We asked executives from leading preferred provider networks of physical therapists to share their experiences in what may be their most important work: evaluating the quality of physical therapists.
FROM WHOSE PERSPECTIVE?
Quality is of course in the eye of the beholder, with patients ranking their physical therapist (PT) primarily on the basis of interpersonal chemistry.
"Our research shows patients want to be treated with respect. They want the PT to spend enough time with them, listen to their concerns and provide clear instructions," said Roger Nelson, a Ph.D.-level physical therapist and vice president of MedRisk's research and academic subsidiary.
Tracy Bell, a clinically trained executive vice president of Network Synergy Group, added that patients want to feel engaged.
"Patients do not want arbitrary goals that have no personal meaning imposed on them by a therapist who is merely going through the motions. They want to be an active participant in their recovery process," she said.
Physical therapy networks track patient satisfaction through patient surveys, but in their own evaluations they rely more on the clinician's professional profile and practice measures. For Jan Richardson, the chief clinical officer of Universal SmartComp and a former professor of physical therapy, it takes a new physical therapist about five years to attain the proficiency she is looking for in practicing in occupational medicine.
Richardson likes a PT to have a master's or doctoral degree and be a member of the American Physical Therapy Association. Membership in the APTA provides access to resources and advanced board certification that is not available when physical medicine is provided by nonlicensed staff, according to Richardson.
All three executives agreed that their network PTs should be focusing their practice on the physical conditions typically experienced by injured workers. For instance, Nelson looks for physical therapists who have had extensive experience with injured workers, as they "will have more focus on return-to-work strategies than clinicians whose practices focus on a Medicare or group-health population."
"There are things you learn about how to best manage workers' compensation patients through experience," Bell said, such as how to manage the malingering patient and how to communicate with claims adjusters.
THE CRITICAL FACTOR
An overriding element of quality among physical therapists in workers' compensation is commitment to documenting treatment plans and outcomes. The executives interviewed for this piece believe that good documentation is not just important clinically but also essential in meeting the needs of claims payers. Each of the three provider networks monitors its network providers for adherence to documentation standards.
According to Bell, good documentation is "a weak area in our field and a recurring frustration in my position."
"It is one thing to be able to treat a patient and get them better, but if we can't write and explain our importance in the rehab component, then we will never be able to justify why PT is needed," she said.
Indeed, managed care's soul sings aloud in the question: "Is it needed?"
December 10, 2010
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