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9 minute read |

Breaking Down Barriers to Physical and Occupational Therapy

There’s a good chance that as you read this, you’ve got a crick in your neck, lower back pain or stiffness in one of your joints. Musculoskeletal disorders (MSDs) affect more than half of U.S. adults and are the most prevalent chronic condition in the working population. They’re having a major impact on employers, as well – as the costliest and fastest growing group of medical conditions to hit employer healthcare budgets. The direct medical costs increasingly include high-cost orthopedic surgeries and specialty drugs such as Humira, Enbrel or Remicade. With a focus on managing high-cost claimants, that makes MSDs a key concern for employers.

Then there are the indirect costs of lost productivity and lost wages. These are felt by employers and reverberate across the US economy. Direct and indirect costs of MSDs impact our gross domestic product (GDP) so heavily that they are on the scale of US defense spending.

When it comes to work-related illness or injury, MSDs account for 31% of all cases with days away from work. They are also a top cause of lost and restricted work time. Factor in the cost of hiring and training replacement workers, especially in a tight labor market, and MSDs cost employers five times more than direct medical costs alone.

Why Consider Offering Physical Therapy Services in an Employer-sponsored Clinic Setting?

When Polk County School Board (PSCB) in Florida first looked at bringing physical therapy services in-house they were focused on their occupational health and workers’ comp cases. “We wanted to see better outcomes,” explains Tiffany Combee, the PSCB risk manager at the time and now a Healthstat account manager. It’s a sentiment echoed by Debby Acuff, workers’ compensation and risk coordinator for Independence School District in Missouri who says, “We were seeing employees go through surgery and return to work, only to suffer a reinjury.” That situation changed dramatically when physical and occupational therapy services were brought into their Healthstat clinics. The reasons for improvement in outcome were enough to convince both employers to offer onsite physical therapy services for personal as well as occupational health. It was a matter of breaking down barriers.

“Physical therapy is one of the most well-adopted ancillary services in terms of treatments that providers will recommend,” says Erin Eason, National Director for Clinical Consulting Practice at CBIZ. “It’s also one of the most challenging for patients to comply with because there are so many barriers.” She points to the wait for an initial appointment, and physical therapy regimens that require frequent visits – often multiple visits within a week. Out-of-pocket costs can be prohibitive for employees. “Bringing services in-house allows you to make treatment more cost effective. You’re offering patients a familiar setting with convenient hours and location. And when patients and their providers are communicating, there’s always an opportunity to close loops if someone’s not doing as well as they should be.” As a treatment option in many situations, physical therapy has similar efficacy with less risk and lower cost than surgery or prescribed medication.

Lee Coleman, DPT, a physical therapist at Healthstat’s Waukesha Employee Health and Wellness Center says that without the cost barriers and delay to first appointment, earlier intervention is allowing him to see the kind of results he wouldn’t get if patients came to him later. “It’s not unusual for one of our providers to walk a patient down the hall to me,” he says. “It gives me a chance right then to let the patient know I can help, which encourages them to start treatment. It’s because of the access and the environment this setting provides that we’re getting such great outcomes.”

The Right Treatment in the Right Place at the Right Time

Eliminating delay to treatment time and encouraging adherence to a frequent visit schedule are just two of the benefits of offering physical therapy and occupational therapy through an employer-sponsored clinic. Another benefit is that a therapist can closely tailor treatment to each patient’s ongoing progress and needs rather than having an insurance carrier authorize treatment based on a predetermined schedule. For example, if a predetermined treatment schedule is longer than needed, it can delay a return to work. On the other hand, if the predetermined schedule isn’t enough for a patient, there can be a break in continuity of care while steps are taken to add to the schedule. In an onsite setting, the physical therapist and prescribing provider can work hand in glove. Treatment can be more efficient, matched more closely to each patient’s needs. The chart above shows the net impact of tailoring the number of visits to each patient, with fewer overall visits required to successfully close occupational health cases.

“It’s not unusual for one of our providers to walk a patient down the hall to me. It gives me a chance right then to let the patient know I can help, which encourages them to start treatment.”

- Lee Coleman, DPT, Physical Therapist, Waukesha Employee Health and Wellness Center

In a wellness setting, such as an employer-sponsored health center, the importance of personal health goals can also be prioritized. If a patient’s passion is swimming, for example, a wellness-oriented approach recognizes the long-term health and productivity benefits swimming provides. The resounding message across the spectrum of healthcare today is that being active and doing what we love helps us to stay strong and healthy. In turn, that lowers health risks related to chronic conditions like hypertension, diabetes and depression. Further, in a job that includes physical requirements, a mentally and physically healthy person will have lower risk of injury from overexertion, poor balance or depression-related distraction while on the job.

There’s yet another prevention component to a physical therapist’s services in the employer-sponsored clinic setting. The PT can be brought into a preemployment screening to demonstrate the best ways to avoid on-the-job and repetitive motion injuries. Showing an employee good lifting mechanics, offering ergonomic assessments, and providing guidance to minimize strain during job performance can help reduce physical wear and tear and prevent job-related injury.

Breaking the Cycle of Chronic Pain

Chronic pain and depression are often experienced together. And together, they drain well-being, vitality and productivity. Patients with chronic pain are 3 times more likely than those without pain to meet the diagnosis criteria of depression. Overall, the chance is 50% that someone with chronic pain is struggling with depression or anxiety at the same time.

Pain and depression also cause people to cut back on physical activity which can lead to further muscle decline, deconditioning and fatigue. People need to keep active and moving to maintain good circulation, hold back inflammation, keep muscles and bones strong and retain their motor control. Inactivity can also lead to weight gain, with the cascade of health risks that come along with overweight and obesity.

Consider the example of an employee who suffered from chronic knee pain. Billy is a fleet maintenance manager with more than 20 years of experience. He says, “After 6 weeks of having to sleep in a recliner due to constant knee pain I finally gave in and went to see my doctor.” He was referred to an orthopedic surgeon and felt lucky when the surgeon said he might be able to avoid surgery by doing physical therapy. He didn’t feel so lucky when he found out how much it would cost and how much time it would take. Billy knew his employee health and wellness center offered physical therapy with no copay, so he decided to check it out. There was one more thing. “With limited physical activity because of my knee pain, I also managed to gain quite a bit of weight,” he explained. “I decided it was time to make some drastic changes.” At first, Billy tried losing weight on his own, only to find mixed results. Then he sat down with the wellness coordinator at his clinic. She set him up with a weight management program to work in conjunction with his physical therapy, while the onsite clinician kept him monitoring his health numbers. He continued to see the clinician and wellness coordinator after his physical therapy was completed. His overall mood and outlook improved along with his knee pain. And he lost a total of 60 pounds over time. He says, “At first I thought the requirements on what, and how much I could eat would be unachievable. But it wasn’t. It hasn’t been just a weight loss program but a lifestyle change that has been easy to follow. My knee feels dramatically better, health reports have improved, and the meals are quick and delicious.” Billy gives credit for his success to the direction, motivation and follow-ups he received from his whole team at the onsite clinic.

Close follow-up is also key to successful recovery after surgery. When Polk County School Board first implemented physical therapy services in its employee health and wellness center, their third-party insurance administrator directed a patient to the PCSB clinic for follow-up after rotator cuff surgery; she had had two prior rotator cuff surgeries, both of which ultimately failed. She had returned to work after the first two surgeries only to reinjure herself and require another surgery. Her third surgery was finally a success because of the true one-on-one approach the PCSB physical therapist was able to provide. The employer-dedicated clinic schedule allowed the therapist to focus on one patient at a time. She could take time showing the patient exercises to do at home and monitor her more closely to respond to her needs as they developed. As a result, the patient was more actively engaged with her therapy. And her return to work was successful.

Fighting for a Championship

Whether for wellness, an injury or both, physical therapy can help an employee get back to their best selves – mentally and physically resilient. Among our most dramatic examples of this is Josh, a schoolteacher in Wisconsin who is also a fierce competitor in Brazilian jiu jitsu. Josh was at the gym training for a national jiu jitsu championship event when he heard several pops in his knee and knew it could be a serious injury. First thing in the morning, he called his employee health and wellness center and got in for a same-day appointment.

Results of an MRI showed a serious ligament sprain, knee bruising, muscle strain and excess fluid buildup. Fortunately, it would be treatable with physical therapy. Josh was extremely happy with the care he was given by physical therapist Lee Coleman. Josh arrived at the clinic on crutches, but Lee told him right away, “No. If there’s no pain you shouldn’t be using crutches for this injury. You have to maintain your strength and range of motion.”

Lee worked Josh hard to get him back to competition level. At one point, Josh even decided to schedule the rest of his appointments after work, so he wouldn’t go into his classroom still sweating and breathing heavily.

Hard work and the support of his physical therapist paid off. Lee knew the best way to handle Josh’s athletic injury and gave him exercises to do outside the clinic. Together, they got his knee back to 100 percent. Josh flew out to Las Vegas ready to compete in the American National IBJJF Jiu-Jitsu No Gi Championship. He won first place in his weight division. Josh credits Lee for helping him be ready to compete. He’s grateful for the quality of care he received at his employee clinic.

This champion’s advice to others thinking about using clinic services? “Just go! The clinic is convenient, cost-effective, and it’s easy to schedule same-day appointments.”

High Quality Meets Low Cost while Improved Outcomes Build Trust

The success of physical therapy services in the onsite clinic helps build confidence and trust among employees. It’s an employee benefit that frees up access to the kind of care that can give back control of their lives to people who are in pain. It enables people to return to work unencumbered by physical pain and the mental anguish that goes along with it. And that’s an outcome that patients and their coworkers can’t help but notice. Like our schoolteacher Josh, it makes employees tell each other to “just go” to their employee clinic for help. When patients are more proactive and address symptoms with early treatment, the best outcomes are possible. The good news for employers? That translates into reduced costs and reduced claims for both personal and occupational health.

Want to learn more about how to evaluate potential cost savings of in-house physical and occupational therapy for your employees? Contact us today.

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