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Working occupational medicine into your practice

Rehab Regs, June 18, 2000

In times of challenging reimbursement, occupational medicine could be an excellent way to increase your patient base and provide a steady source of referrals.

It can open up new product lines to rehab therapists, such as prevention, case management, and risk management, says Jerry Fogel, MS, PT, diplomate of the American Board of Quality Assurance and Utilization Review Physicians. And providers receive full reimbursement for the services they provide. There are no copayments, deductibles, or caps.

Occupational medicine-which includes industrial rehabilitation-deals with rehabilitating people who have been injured on the job to their pre-injury condition. The benefits, provided under workers' compensation insurance plans that employers contribute to, include both health care benefits and an indemnity benefit that replaces an employee's wages while he or she is out of work due to the injury. Since workers' compensation is a state-sponsored plan, benefits vary from state to state, but health and wage replacement benefits exist in all plans.

Fogel says the most common setting for handling workers' compensation cases is in an outpatient rehab setting. It can also be done in outpatient departments of hospitals or as part of therapy performed in association with a physician practice. And sometimes therapists contract with, or are employed by, urgent care centers that provide acute care to workers' compensation patients. Occupational medicine is unlikely in the inpatient setting unless a patient needs procedures such as surgery, or is undergoing a program to manage chronic pain.

Description of servicesHere are three ways Fogel says therapists can participate in occupational medicine:

Direct patient care. Therapists can provide rehab therapy to workers' compensation patients during the acute, subacute, or chronic phases of care. During the chronic phase (beyond three months of treatment), therapists must also be prepared to deal with a patient's anxieties and concerns about getting back to work.
The role of assessing a patient's injuries and course of treatment is critical in workers' compensation cases, requiring additional "forensic" ability on the part of the therapist, says Fogel. Therapists must provide this information to the insurance company after the first visit so the insurance company can evaluate the claim at the onset of the injury. Fogel says these are some of the things you will need to determine:
- Whether the patient is injured and the injury is work-related
- What type of treatment is indicated and what the probable outcome will be
- Whether you have the skills to help the patient reach the outcome
- The functional consequences of the injury-does the patient need to take time off from work or go on modified duty, or can he or she go back to work full duty while receiving therapy?
- When the patient should be able to return to work
Prevention programs. Occupational medicine offers therapists a way to work with employers to help prevent injuries. Here is a list of the ways Fogel says therapists can interact with employers:
- Help to define or modify tasks associated with each job to make sure that they are well- designed and safe
- Develop hiring criteria to help determine what type of worker can perform a given job
- Provide functional testing to new and existing employees to be certain they are capable of performing certain tasks in a safe manner
- Develop exercise programs and body mechanics instructions to help avoid injuries
Fogel says that three big areas for OTs are hand and upper extremity injuries, functional testing, and work hardening programs.
Case management. Fogel says that many PTs work as case managers or utilization reviewers for insurance carriers or for employers. In this role, they help to determine such things as who needs care and whether enough care has been provided to a patient. Some challenges with workers' compensation cases
- Legal implications. Since workers' compensation cases sometimes result in court proceedings, you may be required to testify regarding your care of a patient. So you'll need to provide very objective, detailed documentation to back up your assessments and care of the patient, says Fogel. "You better know your business because you have to be more responsible," he says. But the positive side is that therapists play a key role in providing information on the functional ability of a patient.
- Challenges with patients. Working with the workers' compensation population can be frustrating, says Fogel. Patients don't get better as fast as other patients because they're also dealing with anxiety over being out of work. Also, they are often angry at their situation, partly because they have less control in this setting (e.g., they must go to the doctor or they will lose their benefits).
- Coordinating with insurance carrier. It can also be challenging to coordinate all the details of treatment with insurance companies, says Fogel.
- Reimbursement issues. Fogel says that reimbursement can sometimes be frustrating due to the complicated rules and regulations of workers' compensation. "On the other hand, if you can work through that maze it can be very beneficial because it's an unlimited first-dollar, every-dollar deal," he says.