Back to work, sooner rather than later--Outpatient rehab can speed the return for employees, whether they've been injured on the job or have missed time due to a major illness.
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Employers looking for ways to keep their workforce healthy and productive and their medical costs in check would do well to focus their efforts on the employees most likely to need expensive care. An employee with a chronic condition such as heart disease, diabetes, or hypertension uses significantly more health services than the average person (see Table, "The 15 Most Costly Medical Conditions," below). That means more hospital stays, more prescription drugs, and more emergency room visits. Workers with back pain, arthritis, and other muscle and joint pain cost American employers more than $60 billion a year in lost productivityand most of those costs are the result of sub-par job performance, not absenteeism. 1
One cost-saving solution for employers is to choose health plans that include outpatient rehabilitation services. Outpatient rehabilitation therapists, including physical and occupational therapists, have much to contribute in the way of disease management, injury prevention, and health maintenance. Studies have shown that placing injured workers in physical therapy early in the course of treatment is linked to fewer doctor visits, earlier discharge from care, fewer restricted workdays, and fewer days away from work.2 For a look at how physical therapy works in nine different conditions, from heart disease to cancer, and from mental disorders to physical trauma, see the sidebar "How Rehab Helps," below.
Recent medical advances allow more people to survive serious illnesses such as cancer and heart disease. Rehabilitation helps them recover from those illnesses, regain strength, and return to productivity. Providing rehabilitation therapy soon after surgery helps patients become ambulatory to avoid further complications. There is evidence that "pre-habilitation" offers benefits as well: Physical therapists at the University of Missouri found that exercising prior to surgery can condition the body and speed recovery after an operation.3
In all settings, the timing of rehabilitation is important: The earlier stroke patients begin rehabilitation, for example, the sooner their brains "re-wire," and the better their chances of recovery.
Therapists educate patients with chronic conditions on how to adapt to their limitations, maximize their productivity at work, and achieve a healthy lifestyle. Regular exercise in and of itself has been shown to help alleviate coronary artery disease, hypertension, obesity, diabetes, and osteoporosis. Therapists offer approaches to weight management that include an exercise prescription to burn calories as efficiently as possible.
Employers can reduce their workers compensation costs as well as their medical costs by using industrial rehabilitation therapists to prevent and treat workplace injuries. These therapists:
Some companies also use therapists for jobsite analysis and pre-placement screenings of job applicants.
If employees are hurt on the job, they need prompt physical therapy to facilitate a safe return to work. At the same time, therapists can educate workers on breaking dangerous habits, such as improper lifting, and help them learn to move in new ways to avoid re-injury.
About 93 percent of U.S. companies now offer some kind of health promotion program, up from 89 percent in 1996.4 Encouraging wellness is a win-win for employers and employees because people who are in good shape to begin with are less likely to suffer from injuries and illnesses, and to recover more rapidly if they do.
Physical therapists are uniquely qualified to run wellness programs because they have experience and knowledge about how the body moves, and in-depth training to assess problems and deal with participants limitations. The programs may include onsite exercise classes and supervised use of gym equipment as well as health screenings and workshops on issues such as weight loss and smoking cessation.
When choosing rehabilitation practitioners, the private practice physical therapy setting is the most cost-effective venue in which a patient can receive care. Studies published in the New England Journal of Medicine5and the Journal of the American Medical Association6 have shown that patients treated by independent therapists received more quality care and needed fewer visits than patients treated by therapists who work in physician-owned clinics.
A therapy network of private practitioners should offer broad geographic coverage for easy patient access and provide a wide range of services including physical, occupational, speech, hand, and pediatric therapy. The network should also cover specialty areas such as workers compensation injuries, ergonomic assessment, and geriatrics. Physical therapists specializing in the care of older patients deal with conditions such as osteoporosis and arthritis and offer special services, including balance training, fall prevention classes and "Fit After 50" wellness programs.
Ideally, the network should require that providers meet strict membership criteria and stringent credentialing requirements that surpass those required by the National Committee for Quality Assurance (NCQA).
Aided by the expertise of rehabilitation practitioners, employers can help their employees manage and recover from costly illnesses and conditions, promote wellness and safety for all workers. Bottom line: Effective control of health care costs, and increased worker productivity.
1. Stewart WF et al: Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003;290:2443-2454.
2. Zigenfus G, Yin Y, Giang G, et al. Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. J Occup Env Med 2000;xxx.xxx.
3. "Exercise Before Surgery Aids Recovery, Reuters, September 17, 2002
4. "Health Promotion/Managed Health Provided by Major US Employers in 2001"; "Health Expectations: Future Strategy and Direction," Hewitt Associates, 2002.
5. Swedlow A, Johnson G, Smithline N, Milstein A: Increased costs and rates in the California Workers Compensation System as a result of self-referral by physicians. N Engl J Med 1992; 327:1502-1506.
6. Mitchell JM, Scott E: Physician ownership of physical therapy services: Effects on charges, utilization, profits, and service characteristics. JAMA 1992;268:2055-2069.
|Total spending||Population reporting the condition|
|Heart disease Cancer Trauma Mental disorders Pulmonary conditions Diabetes Hypertension Cerebrovascular disease Osteoarthritis Pneumonia Back problems Kidney disease Endocrine disorders Skin disorders Infectious diseases||$57.5 billion $45.5 billion $44.2 billion $29.7 billion $29 billion $19.7 billion $18.2 billion $16.3 billion $16.3 billion $16.3 billion $13 billion $9.7 billion $10 billion $8.8 billion $5.8 billion||17 million 8.7 million 37.2 million 20.2 million 41.5 million 9.9 million 27.4 million 2.3 million 16.1 million 4 million 13.2 million 2.2 million 18.6 million 19.6 million 16.4 million|
Source: Cohen JW, Krauss NA: Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Affairs 2003;22(2):129-138. Data are from the US Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1997.
Rehabilitation plays a crucial role in the treatment and management of many of the costliest medical conditions.
Breast cancer survivors with lymphedemaswelling of the arm or hand that occurs after removal of lymph nodes under the armmay go to lymphedema-certified therapists who use noninvasive techniques to reduce the swelling.
Men who have had prostate cancer may suffer from urinary incontinence. In many cases, physical therapy involving biofeedback as an adjunct to exercise will help.
*Receipt of cardiac rehabilitation services among heart attack survivors19 states and the District of Columbia, 2001. MMWR 2003;52(44):1072.
Michael Weinper. Managing the Most Costly Medical Conditions.
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