Not Your Father’s Physical Therapy
A house-call approach means the patient is more engaged and treated in a comfortable environment
Once upon a time, injured workers who needed physical therapy (PT) would leave work, drive to a clinic where there were throngs of other patients, and spend about an hour doing a combination of machine-based exercises and—at least to some extent—talking with a physical therapist. Those days may be going by the wayside, along with much of the expense and hassle.
A new model of PT is emerging in the workers compensation system, one that brings the physical therapist to the worksite to focus solely on the injured worker—his or her schedule, specific job tasks, and the physical requirements of the job. Companies that have made the transition to this on-demand PT model have stepped into it cautiously and have been pleasantly surprised.
“Most people think you have to have a big space and a lot of equipment and that on-site PT is too complicated. But it’s not,” says Monnie Kinlaw, a utilization nurse manager for Marriott International. “We are doing mobile PT in medium and small facilities. We’ve been very successful in implementing it.”
In fact, Kinlaw says the company has seen its workers comp costs decrease by 30% at the facilities where mobile PT has been implemented. During the recent National Workers’ Compensation and Disability Conference® & Expo, Kinlaw also said the number of PT visits per claim often is reduced when therapy is done on site. Employers that have adopted the on-site model say the reason for fewer visits, and one of the primary benefits, is the focus on return to work (RTW).
The clinic-based model of physical therapy typically includes patients from group health, private insurance, and Medicare, as well as the workers comp system. Therapists must work simultaneously with this variety of patients.
“The traditional model of physical therapy is a reduction of symptoms,” explains Daniel Sanchez, vice president-operations and a founder of OnSite Physio, which provides mobile PT services in the workers comp system. “The focus of on-site PT is return to work. That needs to be our consistent end goal.”
Sanchez describes mobile PT as being similar to a house call, where the patient is more engaged and is treated in a more comfortable environment than a clinic. In addition to working with the injured worker for a solid hour, the therapist is typically the same person who provides services throughout the injured worker’s treatment. The therapist comes to understand each patient and his or her particular fitness level and needs.
“We’ve been getting great feedback from dance members that the therapist is helping them quickly, and they are back doing their daily activities within an hour,” says Sandra Ortiz-Palacio, the adjuster for workers comp claims among entertainers for Royal Caribbean International. The dancers and other cast members spend four to six weeks training at a Miami-based facility before being sent out
on cruise ships.
“They are dancers. This is what they do for a living. They know their bodies, but the therapist helps them tweak themselves back to 100 percent,” Ortiz-Palacio explains. “They like the fact that they can discuss their symptoms right there and are able to follow the therapist’s recommendations.”
“Some of them said that they felt the therapy they had been getting [at a clinic] was very basic and not as advanced as they thought it should be for their fitness level,” Sanchez says. With mobile PT, “they really feel like someone is listening to them and not just having them do air squats.”
Preparation is key
Vital to understanding an injured worker’s specific needs is knowing exactly what he or she does each day. Sanchez says that once his company has signed up with an employer, the therapist spends time becoming familiar with the employer’s facility.
“We had several meetings before we put this in place [at Royal Caribbean].We saw the dance studio,” he says. “The therapist observed many shows and saw practice routines; he’s constantly observing what the dancers do.”
The preparation process is an essential component of successful mobile PT, he adds. He recently spent a week with a traveling circus to prepare. “We did a full analysis of the show,” Sanchez recalls. “We knew that the guy who’s shot out of a cannon has certain risk factors. People who do tumbling have risk factors. We explained to the employer that the physical therapy needs to be tailored.”
The insight such prep work provides is invaluable in treating injured workers and getting them back to work sooner. Sanchez cites the case of a client that provides waste hauling services. “If I say, ‘This is a sanitation worker’ and I’m in a clinic, I used to think I knew what that meant,” he says. “Not till I did a ride-along and looked at how these workers are pushing and pulling, and how much time they spend working in the heat, could I say, ‘This is what the job entails.’”
Mobile physical therapy has a unique advantage over other models in that the therapist can see exactly what the injured worker does on the job and how he or she does it. These observations allow the PT to provide therapy that is focused on ability rather than disability and results in quicker recoveries.
“We want to get to the injured employee as soon as possible after the injury and identify what he or she needs so we can incorporate that into the physical therapist,” Sanchez says. “What do they do for a living? What do they need to do day in and out for that shoulder or knee? By being on site we can observe, touch, and visualize. In a clinic, we need to make an assumption. On-site therapy enhances the RTW program.”
He likens on-site physical therapy to a sport. If a football team’s quarterback suffers a sprained ankle, for example, he is treated by trainers on site who specialize in helping football players get back on the field to do their specific jobs. “In a clinic, you have to create a story in your head of what [the injured worker] does,” he explains. “But once the therapist can see why the injured worker is hurting and see that the object he or she is lifting is awkwardly shaped, he or she has a better feel for the situation.”
In outpatient clinics the ratio of patient to therapist is about three to one, whereas for worksite therapy it is one to one. In typical home health PT, the focus is on helping the person function within their home rather than on returning to work. The biggest barriers to on-site physical therapy may be its unfamiliarity and preconceived ideas about the traditional models. Advocates hope that workers comp participants will come to appreciate the benefits of mobile PT.
“We definitely see this as a great benefit for companies that have a lot of workers comp claims because the worker can be treated at the facility and return to work within an hour instead of having to leave work early to drive to a clinic and probably not be able to return to work that day,” Ortiz-Palacio says. “Providing on-site physical therapy is a great benefit for employers and injured workers.”
Nancy Grover is a veteran journalist and media relations consultant for the insurance industry. For the past 14 years she has chaired the National Workers’ Compensation and Disability Conference & Expo. She can be reached at firstname.lastname@example.org