There’s yet more evidence that treatment patterns vary significantly across providers. Today’s evidence comes courtesy of two academic institutions and Medrisk, Inc. (consulting client) which reported significant differences in the type and duration of physical therapy provided to workers’ comp claimants.
The study looked at several variables contained in billing data: location of service, duration of care, type of care, and other data points; the data was case-mix adjusted.
There are several key takeaways:
- corporate physical therapy centers billed for more visits and more units per episode than other practice settings.
- there was a “large difference in treatment utilization between geographic regions regardless of practice setting, diagnosis, body-part treated or surgical intervention”
- these corporate centers billed for “a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.”
These findings were consistent across diagnoses and after controlling for surgical v non-surgical cases.
Let’s look at the second takeaway. It should come as no surprise that the type, volume, and delivery of medical care one gets varies a lot from region to region. While one would like to think that the care we get is based on science, in many instances the care you receive depends more on where your provider was trained, the local standard of care, and the personal opinion of the treater than what has been scientifically proven to work.
That said, the final point – that treatment in line with evidence-based medical (EBM) guidelines is more common in corporate settings is…intriguing.
Increasing the use of treatments for workers comp claimants that are in line with evidence-based medical (EBM) guidelines is a primary goal of many payers, regulators, and other stakeholders; WCRI’s just-published review of state workers’ comp regulations provides ample evidence of this trend. While there could well be reasons the use of treatments supported by EBM were more common in corporate-based settings, the discussion in the report appears to address some of the key factors; delay in initial treatment, severity, and acute v chronic status.
Let’s be sure to recognize that these findings are general, overall, and based on statistical analysis. Undoubtedly there are clinic-based, private, facility-based, and other PT practices that are quite focused on EBM and rigorous in their application. And, to reiterate, there may well be sound and valid reasons for the differences noted by the stdy authors.
What does this mean for you?
1. Good to see research focused on this key area of workers’ comp; with 15 to 20 percent of medical dollars spent on physical medicine, the more we know, the better.
2. Payers should talk to their network partners to find out what type of care their PT providers deliver. If they don’t know, find a network that does.