Using Physical Therapy to Mitigate COVID-19's Impact on Claims

The “out with the old, in with the new” end of the year adage felt more meaningful this year with COVID-19, but unfortunately the virus did not go out with the year.

While the final months of 2020 delivered good news in the form of a vaccine, the workers’ compensation industry will be dealing with delayed recovery claims well into 2021. 

Last March, the American College of Surgeons recommended postponing elective surgeries to reserve resources for coronavirus patients. Researchers estimated it would take 45 weeks to catch up with the backlog.

Patients cancelled or put off appointments. California issued a statewide shelter-in-place order suspending nearly all non-urgent medical services that couldn’t be delivered via telehealth.

The use of telemedicine in comp soared during the pandemic with many payers and patients using telehealth technologies for the first time.  The volume of visits in MedRisk’s well-established telerehabilitation program increased by more than 1700 percent between March and May over the previous year. 

Yet certain conditions require in-clinic care and some patients had to --or chose to-- wait.

Deferring care can lead to overall higher physical medicine costs, higher overall medical expenditures, higher indemnity payments, and longer claim durations, according to The National Council on Compensation Insurance’s April [2020] Economic Impacts of Coronavirus on Workers Compensation.  

Its findings were reinforced by the Workers’ Compensation Insurance Rating Bureau of California’s Cost Impacts of Medical Care Delays in the California Workers’ Compensation System. This study found that “claims with soft tissue injuries that had a month delay before receiving the first medical service had on average, significantly higher indemnity and medical costs than similar claims without medical delays, and the cost differential persists for years after the injury.” 

Lockdowns, layoffs, and uncertainty also led to society-wide surges in anxiety and depression, well-known biopsychosocial barriers to recovery. Opioid abuse skyrocketed as well. The American Medical Association reported a 143 percent increase in opioid-related deaths this year compared to 2019. 

The workers’ compensation industry’s concerted efforts to reduce opioid use had resulted in a decline in opioid utilization on claims at an average rate of three percent per quarter since 2018, according to NCCI. That decline ended during the second quarter when one out of three drug claims had an opioid prescription. Researchers said, “The changing trend is perhaps a further indication of pain management alternatives slowing down and potentially a result of injuries awaiting more direct and critical treatment.”

Access issues combined with substance abuse and psychosocial factors set the stage for longer claims duration. Changing the calendar to 2021 does not erase COVID-19 or close all those claims, but it does give the industry a chance reset our resolve to help injured and ill workers recover as quickly and fully as possible in the new year. 

While early physical therapy provides the best outcomes as the Workers Compensation Institute Research study clearly demonstrates, well-managed physical medicine can promote recovery at any point in the claim.

Injured workers whose treatment was derailed by COVID-19 can benefit from proactive guidance and support from a physical therapist before resuming therapy.  When a treatment disruption has occurred, a physical therapist can proactively consult and assess a patient’s current condition, identify concerns or barriers and educate on course of treatment.

MedRisk’s 2021 Outlook trends report highlights a recent study that emphasized the value of this type of patient education and engagement and other research examining how physical therapy consultation and participation impacted opioid prescription rates and low back pain-related healthcare costs.

As the impact of the COVID-19 pandemic on the workers’ compensation system continues to unfold, it is important to focus on the aspects of recovery that have proven successful.  The inclusion of well-managed physical therapy services, whether delivered via telerehab or in a clinic setting, is an important key to restoring function and mitigating costs related to service delays.

By Mary O'Donoghue

Mary O’Donoghue, Chief Operating Officer of MedRisk, oversees the company's clinical, administrative and operational functions. MedRisk is the leader in managed physical rehabilitation for the workers’ compensation industry. Her responsibilities encompass clinical management, product development, provider relations and network oversight along with patient advocacy and customer service. Ms. O’Donoghue also guides the efforts of MedRisk’s International Scientific Advisory Board (ISAB), including the development and updates of evidence-based guidelines. 

A Registered Nurse, she joined MedRisk in 2016 as Chief Clinical and Product Officer and led the development of MedRisk’s Telerehab program and its On-Site PT offering. Previously, Ms. O’Donoghue held senior leadership positions in strategic planning, operations management, and product development with top carriers, third party administrators, and managed care organizations in the group health, disability and workers’ compensation industries. She is a member of WCRI’s Core Funder’s Board, which sets the Institute’s research agenda.  Ms. O’Donoghue can be reached at modonoghue@medrisknet.com or 610-768-5812 ext. 1040.

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