Considering Workers' Compensation

Why target this business, what does it take and where to start

By Marge Epperson

When you think of your favorite categories of patients, do workers' compensation/industrial rehab patients rank in your top three? For most clinicians, the work comp patient would not be at the top of their list. The perception with this payer class of patients can be negative and includes a complex reimbursement system that requires more work beyond normal physical therapy treatment, communication and documentation. The workers' compensation system can be as challenging as the Medicare system can be. You have to play by the rules or you will not be successful.

Another difference is all the "players" involved with the work comp patient. It is no longer just a patient and a physician to keep satisfied. Instead of two primary customers (physician and patient) there are now three to five, including adjusters, case managers and employers. These new "players" can be the referral source that overrides the physician's opinion. The work comp player's goals do not always match the physician's goals, putting the physical therapist in a precarious situation. This can require the physical therapist to work hard to gain trust and build the relationship for continued referrals.

Having said this, (and knowing I am a minority in my opinion), I would choose a work comp patient over any other. The physical therapist is often the key player in the work comp arena guiding the patient along the continuum of care through the valuable information we provide.

Why should we look for work comp business and work hard to keep it? Even with some of the recent insurance re-pricing and state fee schedule changes, work comp payers are still averaging some of the best reimbursement and lowest insurance adjustments. A physical therapy facility can maximize this reimbursement by adding specific industrial rehab product lines to their service mix, such as work conditioning, functional capacity evaluations, functional job descriptions/analysis and post-offer employment testing.

What does it take to get work comp business and then keep it? With consistent follow-through focusing on three key best practices, referrals will grow. The three most important work comp best practices include: 1) communication, 2) functional work-related treatment and documentation and 3) utilization management. These are the keys to success with the workers' compensation "players."

How do you get started or maximize your facility's work comp opportunities? Start with a work comp feasibility study to determine the need for this service in your community. Is your facility located in an industrial area or manual labor/blue-collar area? Are there other clinics within a particular mile radius that offer related product lines (i.e., work conditioning, FCEs)? Next, outline the training needed to start up or grow this line of business based on your staffing and clinical expertise. There are quality comprehensive education and training programs that provide training for industrial programs, program development and provide the software to document appropriately. To set yourself above the general physical therapy practitioners in the area of workers' compensation, you need to be trained in the following areas:

Communication. Know your Clinical Case Management Guidelines: what information to communicate, when to communicate it and who to communicate with. Communication is the key to case closure in the work comp world. The role of the physical therapist is extremely important to the work comp community and can greatly assist or be detrimental to the injury management process.

Work-Related Treatment and Documentation. Understanding work-related functional treatment, i.e., stooping, climbing, overhead reaching, squatting, crawling, lifting, pushing, carrying or pulling, and how to document it is key to work comp best practices.

Utilization Management. Review your systems to assure proper utilization and injury management is progressing along the continuum of care as quickly and safely as possible.

Functional Baselines and Testing. Learn work-related functional baselines and testing for the acute and subacute patient. Train on job-specific functional activities as defined by the U.S. Department of Labor.

Work Conditioning Programs. Complete a specialized program to gain credibility in the work comp community. Education and training will include program criteria, evaluation process, program content, daily treatment plans and progress/discharge assessments.

Functional Capacity Evaluations. Identify methods and options for legally credible formal testing.

Employer Related Services. Complete training on functional job descriptions and analysis, ergonomic consultations, post-offer employment testing, and job coaching. All of these require specific training by experts in their respective specialty areas.

Marge Epperson is vice president of operations with Nueterra Healthcare Physical Therapy Division. She has more than 15 years experience in developing and managing physical therapy facilities and is a graduate of the University of Kansas with a degree in occupational therapy. Nueterra Healthcare Physical Therapy Division specializes in the development and management of physical therapy centers. Nueterra has 27 centers located nationwide and offers up to 60 percent ownership, one of the highest percentage of ownership for therapists in the industry. Visit www.nueterrahealthcare.com