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Moore: Physical Medicine: the Adjusters' Bane

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The Workers Compensation Research Institute's recent study and report on workers' comp physical medicine came as no surprise. After handling, consulting and performing studies on thousands of files, I noticed that when the cost of any medical treatment was reduced, the utilization increased proportionally to offset the reduction.

James Moore

James Moore

Workers' comp physical medicine was the one medical cost that I studied the most for insurance investors, carriers, third-party administrators and providers. One area that has been the bane of claims adjusters for years has been coordinating everything that occurs in a claim to provide proper and timely benefits. WCRI covers an important point on the coordination of workers' comp physical medicine treatment.

When multiple medical providers, including physical medicine, do not sync up their treatment and referrals, the adjuster’s job becomes exponentially more difficult.

WCRI study confirms both points

Extended physical medicine (PM) use was relatively frequent in most study states, and less coordination of care was among the key factors associated with a higher likelihood of having extended PM use.

WCRI studied low back pain injuries. From my experience, all injuries that involve physical medicine have an extended PM use concern.

The basic definition of physical medicine, according to Google/Oxford dictionaries, is "the branch of medicine concerned with the treatment of disease by physical means such as manipulation, heat, electricity or radiation, rather than by medication or surgery" and "the branch of medicine that treats biomechanical disorders and injuries."

The study, "Factors Associated with Extended Use of Physical Medicine Services for Workers with Low Back Pain," is designed to address the following questions:

  • How prevalent is the extended use of PM services, and how does it vary across states?
  • How is extended PM use associated with overall costs and duration of temporary disability?
  • What are the factors that help predict the likelihood of extended PM use, focusing on the factors that can be used for better management of claims and care?

Based on utilization patterns of PM services, the study defined extended PM as claims that had PM services initiated within six weeks of the injury and continued to have PM services after three months. According to the study, some claims with extended PM use may have more serious or chronic conditions that need additional services. However, the frequency of extended PM use appears to be higher than the rate of chronic back pain reported in other studies, suggesting other factors affect the use of extended PM in workers’ compensation.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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