The Workers’ Compensation Research Institute (WCRI) recently published a new report titled The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation?
With an increasing number of workers receiving physical therapy, this study seeks to understand the impact of the physical therapy (PT) treatment pattern on the utilization of other medical resources and outcomes. Specifically, this study examines how the timing of PT impacts:
- MRI utilization
- Opioid utilization
- Pain management injection utilization
- Lumbar surgery
- Overall medical cost per claim
- Number of weeks of temporary disability benefits per claim
This study takes data from 26,000 low-back-pain only (LBP-only) claims from 27 states with injuries arising between October 1, 2015 and March 31, 2017, with detailed medical transactions for the first year of treatment. The 27 states included represent two-thirds of workers’ comp medical benefits in the U.S. and 37-72% of workers’ comp claims in each state.
Data is broken down into five groups, arranged by the timing of PT, as follows:
- PT within 3 days after injury
- PT within 4-7 days post-injury
- PT within 8-14 days post-injury
- PT within 15-30 days post-injury
- PT delivered 30+ days post-injury
Overall, this study concludes that for workers with LBP-only injuries for which PT is indicated, early PT within 14 days is likely to be beneficial, associated with a lower utilization of medical services, lower overall medical costs, and shorter temporary disability duration.
“There is a tremendous opportunity for continued analysis of physical therapy effectiveness and its appropriate utilization within workers’ comp,” comments Tate Rice, PT, DPT, MBA and Director of Clinical Services for Healthesystems’ Ancillary Benefits Management Program. “In addition to the impact of timing outlined in this analysis, other factors to consider are frequency, duration and intensity of visits. Are patients receiving the right mix of passive vs active modalities based on where they’ve progressed in their recovery? Are they going often enough, or too often?”
Among workers who started PT more than 30 days after injury, utilization and cost of medical services were significantly higher than earlier PT treatment. In this group, workers were 46% more likely to receive MRI and 46% more likely to receive opioid prescriptions, compared with those who had PT treatment initiated within 3 days after injury.
Average payment per claim for all medical services during the first year of treatment was lower with early PT initiation – average medical cost per claim for workers with PT after 30 days was 24-28% higher than those who had PT within 3 days of injury.
Later initiation of PT is associated with longer temporary disability (TD) duration. The average number of TD weeks per claim when PT is initiated more than 30-days after injury was 58-69% higher when compared to those who initiated PT within 3 days post injury.