Align Networks

Physical Therapy Management Strategies

November 15, 2011

Presented by:Nicole Matoushek, MPH, PTV.P. Product Development

&Matt Dougherty, V.P. Sales

Align Networks Physical Therapy Program

Align Networks is the premier provider of physical rehabilitation services in the Workers’ Compensation industry National network of credentialed providers Scheduling Visit management Clinical oversight EDI Online web portal for real time claim access

& easy billing

Align Networks Program

Align Networks

Philosophy

Align Networks believes that the front end management of the claim is necessary to deliver optimal clinical outcomes & cost savings in both our prospective and retrospective models

Our philosophy has demonstrated success due

to our ability to positively impact: Clinical Outcomes Customer Service Provider Selection Customer, Patient, Physician & Provider Satisfaction

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Services Offered Nationally

Physical/ Occupational Therapy (75% of referrals)

Chiropractic

Industrial Rehab Services Functional Capacity Evaluations Work Conditioning / Hardening Onsite Therapy Program Job Site / Ergonomic Evaluation

Specialty Rehab Services Certified Hand Therapy Aquatic Therapy Non-traditional services – massage, acupuncture,

speech, vestibular therapy, wound care, gym/fitness

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What & How Injuries in Workplace Happen

Most Frequent Injury Types

Musculoskeletal Disorders! MSDs represent 62% of all Workers’

Compensation claims (OSHA) Most common: sprains, strains, CTS,

fractures, contusions

Ref: BLS, 2005

Musculoskeletal Disorders

WHY is understanding WHAT & HOW of workplace injuries important?

MSDs are EXPENSIVE! MSD: $20B in lost work time, W.C. Costs every

year Expected to rise to $54B in next 10 years Indirect costs associated with every dollar spent

on direct costsfor

everyIndirect: lost due to

decreased productivity and absenteeism

Direct: medical/pharmaceutical

costs

Ref: Liberty Mutual Work Safety Index

Top 5 Leading Causes of

Workplace Injuries

Clinically, ergonomic work-related injuries occur when there is inadequate blood flow or tissue recovery time due to work cycles or exposure to ergonomic risk factorsTissue damage can lead to inflammation, degeneration, loss of function (ROM, Strength), impairment, disabilityInjuries: Overexertion, Repetitive Strain, Cumulative Trauma

Occurs over time with repeated exposure

Ergonomic Related Injuries

What is Ergonomics?

Ergonomics: the “Science of Work” Latin “Ergos” = work, “nomics” =

science/study Presence of one or more ergonomic risk

factor can lead to an increased risk of acute & cumulative trauma injury

A risk factor is any exposure that increases the probability of the occurrence of injury

Increase an ergonomic risk factors is a multiplicative effect, not additive!

What are Risk Factors?

Ergonomic Risk Factors: Industrial

Material Handling Risk Factors:Forceful ExertionHigh RepetitionAwkward Postures & working outside of “optimal” or neutral joint posturesSustained PosturesContact StressPPE/Gloves: Increase grip needed by10%Shift work/schedules/OT

Example: Awkward posture, repetition, sustained postures, gloves

Ergonomic Risk Factors: Office

Risk Factors:

Not just in the industrial setting, they exist in the office setting too!

Common office risk factors: Awkward positions Static postures High repetition/keying Trip hazards: chair mats,

electrical cords

Let’s Look At A Risk Factor

Awkward Postures:

Neutral joint posture= least amount of stress on tendons, ligaments and joints. Also strongest.

Loss of strength of 50% or more when working out of neutral.

Injury risk goes up!

Grip Strength:

Physical Therapy Management Strategies

“You do not get injured workers well to put them back to work. You put them back to work to get them well.”

- Richard Pimenthal

Pro-Active Therapy

Develop goals, treatments based on individual needs

Inherent flexibility of treatment plan 3 x 4 weeks 1-3 x 2-4 weeks

Avoid “prescriptive care” mentality Not all patients require exact same treatment!

Evaluate function, progress regularly (30 Days) Modify goals, treatment as needed

Communicate findings regularly Ensure Patient Responsibility

Involve IW, review goals with IW

Focus on Function

Include functional activities Document objective progress Passive treatments/modalities should be

limited and used only as an adjunct to active exercise (APTA position)

Work-Specific Treatments

Goals should be objective, measurable Focus on RTW objective

Include work-specific activities Real tasks, tools or simulated Refer to job description if available

(Adj/Case Manager) Job Description Job Goal

Visit Monitoring

Monitor entire episode of care; I.E.; visits attended/missed; guidelines; discharge;

outcomes metrics

Review patient’s RTW/SAW status & appropriateness for specialty Industrial Rehab services:

Functional Capacity Evaluation Work Hardening/Conditioning Ergonomic Services

Clinical Guidelines

Extended durations above Clinical Guidelines may be appropriate, review clinical/patient documentation:

ODG, ACOEM, State Guideline, APTA, Other

Slower healing: advanced age, metabolic disorder, meds affect mobility/exercise tolerance

Higher surgery rates (multiple)

Co-morbidities/complications Scarring, overweight, de-conditioned

Proactive D/Cs

APTA Definitions: Discharge vs. Discontinuation Identify I.W.s who no longer require hands-on skilled

care Continue to improve independently? Perform HEP independently? Gym program?

Recommend D/C of therapy services as appropriate (APTA)

Communicate with Physician/CM/Adjuster

P.T. Management Programs

Aggressive scheduling & visit management for entire episode of care; prompt I.E. & regular attendance facilitates healing, RTW & discourages counterproductive behaviors

Steerage to preferred provider based on location, services, & performance; ensures optimal outcomes

Clinical Oversight program; ensures delivery of medically necessary care; Clinical Guidelines, Peer to Peer Reviews

Industrial Rehab Specialization; identifies I.W.s eligibility for FCE/Ergonomics or WC/WH programs, maximize RTW/SAW

Data exchange: reporting & 24/7 online access for Payor; Adjuster/Case Manager; always up to date on therapy milestone updates, therapy progress & status, clinical findings, RX

Thank You!Questions & Answers…….