Copyright © 2004 Business Insurance

"Use of Treatment-Outcome Data Saves Money" May 31, 2004

by Dave Sax and Phil Grosse

 

What are we to make of the seeming contradiction between falling injury rates and rising workers compensation costs?

Too often, medical providers hold a "blank check" in authorizing treatment for an injured worker. The worker simply enters treatment and stays there until the provider says the treatment is finished. In addition, some providers are given authorization for a certain number of visits and will use these visits whether they are necessary or not.

Many employers believe they have no role during this treatment period. But there are ways that employers can empower themselves to reduce costs and make a difference. That power lies simply in their ability to collect, analyze and act upon treatment-outcome data.

Whether your company is in a state that allows you to direct care or allows the employee to select his or her own provider, every medical provider who treats one of your employees has access to the following information:

- The number and type of musculoskeletal injuries that year.

- Reinjury vs. first-time injury rates.

- Average number of therapy visits per case.

- Average therapy cost per case.

- Average total cost per case.

In addition, your company has the ability to add the following data to the mix:

- Average length of restricted work.

- Lost workday rate.

- Average number of lost workdays.

- Number of cases without lost workdays.

- Number of cases with days of restricted work.

- Replacement labor costs.

- Productivity loss.

- Type of "light duty"-productive vs. nonproductive.

The ability to collect and analyze such work-related outcome data is critical to the development of a pla of action. It may be easier than you think.

Quality medical providers, including many sophisticated physical therapy groups, pride themselves on their ability to improve treatment outcomes. In order to prove their value to the employer and insurer, many of them have incorporated tracking systems that provide valuable outcome information.

Employers should seek out providers that are interested in improving outcomes and, thus, in tracking data. This level of accountability is overdue.

Although usually not tracked or made available to therapy or medical providers, lost-time data could be gathered as part of an employer's routine recordkeeping on injured workers. Alternatively, experienced industry consultants are available to assist businesses in developing processes and procedures that assist in the gathering and analysis of work injury-related data.

Once the information is in hand, employers can be on the lookout for the following red flags:

- Lost workdays are routinely incurred.

- Therapy visits average 10 or more per case.

- Reinjury occurs with frequency.

- Light or modified duty averages four or more weeks per case.

- Employees miss two to three hours during the workday to attend therapy visits.

- Light/modified duty is nonproductive.

Any of these conditions indicates that a discussion with the medical provider or an examination of the employer's return-to-work program is warranted.

Another area worth considering is timeliness. Industry studies have demonstrated that there are significant increases in physician visits, case duration and the duration of restricted work when initial physical therapy treatment is delayed by only a few days.

We suggest employers track the following time lines with respect to an initial injury:

- From injury to initial report.

- From initial report to first physician visit.

- From first physician visit to initial physical therapy visit.

- From initial therapy visit to return to full duty.

A company's first efforts to find olutions to work-related injuries are simple and sensible. The company must know and understand what its costs are and where they are coming from. It must understand treatment outcomes. The gathering and analysis of outcome data will facilitate cost-effective and practical decisions. The selection and control of sophisticated providers that can provide valuable treatment-outcome data is critical. Information provides the power to make good decisions.

Dave Sax is former director of operations and Phil Grosse is director of business development for Salt Lake City-based Jobsite Solutions.

© Copyright Business Insurance 2003