Niche market alert: Worker' comp

Rehab Regs, June 13, 2005

Be proactive to get these patients at your facility

Chances are, you've treated some workers' compensation patients here and there, but if you haven't made a conscious effort to introduce yourself as a therapy provider to this group, you probably haven't seen a steady stream of them.

If you're interested in carving out a workers' comp niche for you and your practice, read on to get started.

Add it to the mix

Whether you want the bulk of your total caseload to be workers' comp patients or to supplement the case mix you already have, give some thought to how to attract these patients.

"To have at least some workers' compensation patients can create a really healthy mix because workers' comp payers are generally more timely in reimbursing," says Connie Ziccarelli, chief operations officer for Rehab Management Solutions in Kenosha, WI. "They pay based on fee schedules that are state mandated so they won't typically be delinquent on payment."

In many states, workers' comp reimbursement is higher than what Medicare pays. For example, it runs 125% of Medicare reimbursement in Texas. Refer to your state therapy association, department of labor, workers' compensation commission, industrial accident board, or insurance commission to determine whether the state-mandated regulations and reimbursement rates are right for your facility.

If employers know that you get their employees back to work quickly and safely, you are well on your way to building a solid reputation that could gain you more patients down the road. By showing employers your program's value, you also can increase your future opportunities in injury-prevention programs.

"Every day that a person isn't working, it's costing that employer money," says Ziccarelli. "If you're competent in industrial rehab and can get injured employees back to work, in the long-run you save them money."

But remember that workers' comp is not a one-size-fits-all specialty, cautions Ken Mailly, PT, of Mailly and Inglett Consulting, LLC, in Wayne, NJ. "Aside from tailoring a therapeutic program for specific job requirements, it is important for providers to have a working knowledge of the regulations in their particular state," he says. To offer a truly specialized program, such knowledge is critical, including knowledge of federal standards and fee schedules.

In addition to sending out brochures to physician offices and holding open houses at your facility, try the following tactics to attract workers' comp patients:

Touch base with employers. Whether you target large companies in your geographic area or contact individual employers of the current workers' comp patients you already have, inviting them into the therapy discussion can reflect well on your facility. "When we get a patient, we call the employer for the job description so we can get [him or her] back to work quickly," says Bubba Klostermann OT, CVE, CEAS, chief executive officer of Work & Rehab in Abilene, TX. "They usually say, 'We appreciate you calling and bringing us into this circle,' " he says. The job description will tell you what is required of the patient in his or her occupation and can help you develop the best possible plan of care.

Research industries in your area. Start with the local chamber of commerce, and determine what type of industries and injuries are common in your area. Doing so will help you target any marketing you decide to do.

Don't underestimate word of mouth. Every patient has a spouse, neighbor, or coworker who may need your services down the line. The more patients you treat, the more likely it is that one of them will recommend you to someone else.

In addition to offering itself as a place for workers' compensation patients, Bergen PT Associates in Elmwood Park, NJ, goes one step further. Specializing in work hardening and functional capacity evaluations (FCE), 95% of Bergen's patients are covered through workers' compensation.

"It's a need that's not met in most areas," says H. James Phillips, PT, OCS, FAAOMPT, owner of Bergen PT Associates. "We bridge the gap between traditional PT and the patient's return to work."

Phillips' facility serves emergency medical technicians and employees of municipal departments of public works, fire departments, and police departments.

Work hardening is a combination of physical conditioning and work simulation that can make your practice more attractive to referring physicians. FCEs come into play when the doctor doesn't know to which level of work the patient is capable of returning. To offer these evaluations at your facility, you likely need to pursue continuing education, says Phillips.

Klostermann has also found another way to enhance the workers' comp caseload at his facility.

In addition to finding therapists for employees injured on the job, many employers also conduct drug and hearing screenings, pulmonary function tests, physicals, and other assessments. Instead of dealing with a handful of facilities to meet these needs, Work & Rehab contracts with physicians to assist them in providing all of these services. It provides one-stop shopping for employers while building business and relationships with the physicians.

"Therapists hate to beg for business, and this is a really easy fix for that," says Klostermann. "The [workers' comp] market is so competitive that you really need to look at what adds to your bottom line."

As for any other type of reimbursement, adequately describe the service you performed to receive payment. Therapy goals for each workers' comp patient must be functionally based, with returning to work as the primary goal, says Phillips. To set these goals, you must have knowledge of the physical demands of the job and a way to test functional ability. For example, "Patient X can now lift 20 lbs from floor to waist level while the job requires lifts of 40 lbs," rather than "Patient X has low back pain of 6/10, ROM 50%, MMT 3/5."

"This type of objective testing is beyond the means of most physicians, so a good marketing strategy is to let them know that you can provide this type of information," says Phillips

There is a stereotype about workers' comp patients embellishing their injuries to avoid going back to work. Ignore this stereotype.

"Try not to think of them as workers' comp patients, but as patients who need help," says Klostermann. "Ninety-five percent of patients want to get well and get back to work."

"Most insurers view workers' comp populations as the most challenging because their financial implications are huge," says Mailly. "But if we can help them address the problems they have, they'll come back to us." Thus, these challenges also create opportunity, says Mailly.

Make sure you have the ability in your facility to conduct functional capacity testing and physical ability before you take on a bulk of workers' comp patients and deal with injury prevention and work-conditioning programs. Also be sure that you know what paperwork needs to be completed and any regulations your state may have.

"If you send a worker back to a facility where he or she is expected to be able to lift 50 lbs, you should be confident the employee is functional to that level or you could be liable if they get reinjured," says Ziccarelli. "There are so many ins and outs, it really is a specialty."

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