Bringing in Treatment: Establishing a Workplace Rehabilitation Program
Schiller, Jim, Risk Management
As companies continue to search for ways to reduce their health care expenses, many risk managers are looking to improve the efficiency of physical therapy and other support services to better control indemnity costs and reduce lost work time. One approach adopted by a growing number of companies is on-site physical therapy.
An integrated on-site physical therapy initiative incorporates rehabilitation services with vocational counseling, injury prevention education and exercise programs to provide a well-rounded regimen to injured employees. Injury-prevention efforts available to all employees can include fitness and nutrition education and work site calisthenics or stretching programs. In addition, employees who are treated on site spend less time traveling to therapy facilities and waiting for treatment. With these efforts, employers are often able to reduce the frequency and severity of workplace injuries, and employees are encouraged to take an active part in recovery by focusing on achieving functional gains.
Employers that encourage wellness and healthy life styles can also include the on-site expertise of rehabilitation professionals to improve the continuum of care offered to employees. "Our rehabilitation provider helps us maintain a healthy work environment," says Joe Miller, regional loss prevention manager for Coca-Cola Enterprises. "They educate our managers, provide educational services and identify risks and hazards associated with various jobs.
Assessing the Need
Organizations with high rates of workers' compensation and cumulative trauma injuries, such as those involved in manufacturing or other industries that rely on physical labor, may be appropriate candidates for implementing on-site physical therapy programs. To help identify whether such a program will be effective for a specific company, the employer and provider will compare a number of statistics - injury rates and severity, indemnity costs and lost work days - with industry and regional averages to identify the tasks or procedures that are generating the most frequent or severe incidents.
Depending on a company's loss experience, the financial and space requirements of implementing an on-site physical therapy program can actually be a cost-effective alternative. If an employer is able to provide approximately 500 to 1,000 square feet, and the therapy provider company supplies its own equipment, the employer's costs are actually less than $10,000. If the provider is able to use existing equipment, such as in an employee exercise room, the costs can be lower.
The liability exposures associated with on-site therapy generally depend on the circumstances of any employee injuries. A therapy provider will bear the liability, for injuries that are received during patient care. Liability for most other injuries will probably depend on who owns the equipment involved in the incident. For example, if an employer rents equipment from a provider company, the provider will retain the liability. If an employee trips over a mat in an employer-owned center, the exposure belongs to the employer.
Payment arrangements for on-site physical therapy can be customized to the company's needs and the workers' compensation regulations of a specific state. The fee-for-service method is traditionally used where rehabilitation services are billed directly to the workers' compensation insurance carrier. Self-insured companies can also contract directly with a therapy provider for a negotiated fee.
Therapists working at on-site centers are also trained to establish and manage injury prevention programs. A typical program begins with an injury trend analysis, where therapists review background information and medical records. To develop recommendations about avoiding injuries, therapists also observe job tasks to identify the physical demands. When an employer needs precise information, a rehabilitation provider can perform ergonomic and biomechanical video analyses. …