On-site Physical Therapy: A Strategy to Free Injury Prevention Dollars Drew Bossen, PT, MBA Atlas Ergonomics

Transcription

1 On-site Physical Therapy: A Strategy to Free Injury Prevention Dollars Drew Bossen, PT, MBA Atlas Ergonomics Thursday, December 4, :15-3:15 PM

2 Who we are Interventional Matrix The current spend where the dollars flow The dirty little secret of healthcare The structure that produces dollars How PT s can help you The payback Agenda

3 Interventional Matrix Case Management Total Systems Approach Return to Work Evaluation Rehab Services Reactive Ergonomics Recordable Event Employee Triage Pro-active Ergonomics & Wellness Discomfort Pre-work Screens Essential Function Profiles of Jobs

4 Interventional Matrix Case Management Get them back to work quickly Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Help them avoid injury Employee Triage Discomfort Pro-active Ergonomics & Wellness Hire the right people Pre-work Screens Essential Function Profiles of Jobs

5 Interventional Matrix Case Management Return to Work Evaluation Reactive Approach Rehab Services Reactive Ergonomics Recordable Event Proactive Approach Employee Triage Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs Discomfort

6 Interventional Matrix Case Management Case Management Return to Work Evaluation Rehab Services Recordable Event Medical Management Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

7 Interventional Matrix Case Management Return to Work Evaluation Data Flow Rehab Services Reactive Ergonomics Recordable Event Employee Triage Pro-active Ergonomics & Wellness Discomfort Pre-work Screens Essential Function Profiles of Jobs

8 The Flow of Dollars

9 Recordable Injury The Flow of Dollars Pain & Dysfunction Discomfort Root Causes

10 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

11 The Flow of Dollars

12 2,800 individual CPT codes during Q1 On average 1 visit = 3 codes 2800 Codes / 3 Codes per Visit = 933 Visits Number of working days per Month 21 days Hence 63 working days per Quarter 933 visits / 63 days = 14.8 visits per day Utilization 14.8 visit per day would be deemed a VERY REASONABLE workload by any physical therapist

13 Utilization Salary of a well paid physical therapist $80,000 - $120,000 $20,000 - $30,000 per quarter

14 The Flow of Dollars Salary of a well paid physical therapist $80,000 - $120,000 $20,000 - $30,000 per quarter

15 Breakeven Point Assume a Salary of $30,000 per Quarter Average cost per Code = $58.62 $30,000 / $58.62 = Codes per visit this equals working days per Quarter this equals 2.7 PT visits per day Perhaps 3 hours of actual PT time per day What to do with the remaining 5 hours each day???

16 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

17 Measurement of Essential Functions The Job and its Essential Functions Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands

18 25

19 50 lbs 10 lbs 45 lbs 37 lbs 47 lbs 20 lbs

20 Measurement of Essential Functions The Job and its Essential Functions Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands

21 Measurement of Essential Functions The Job and its Essential Functions Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands

22 Job Demand Analysis

23 Matching The Work and Worker Pre-work Screens

24 Pre-work Screens 6% 5% 4% 3% 2% 1% 0% Q Q Q Q Q Total Driver PWS Failure %

25 Pre-work Screens Drivers Warehouse Failed: *Est. Injuries Prevented (18%): 24 5 **Est. Direct Costs per Injury: $38,635 $38,635 **Est. Indirect Costs per Injury: $7,040 $0 Savings: $1,093,460 $201,675 Total Quarter Savings: $1,295,134 Total Quarter Cost: $205,978 Quarter Payback: 6.3 * Estimated injury rate taken from 4 year PWS study **Provided by Work Comp Note: Does not include the job applicants who self-select out of the process. Quarter PWS Cost Savings

26 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

27 Reactive vs. Proactive Ergonomics

28 Proactive Ergonomics Filter the Population

29 Managing Discomfort Drivers Reporting of High & Extreme Discomfort vs. Direct WC Costs 25% $20,000,000 20% 15% 10% 5% $15,000,000 $10,000,000 $5,000,000 0% $0

30 Managing Discomfort Drivers Reporting of High & Extreme Discomfort vs. Direct WC Costs 25% $20,000,000 20% 15% 10% This represents a 45% decline 5% in Direct Costs 0% $15,000,000 $10,000,000 $5,000,000 $0

31 Level I Audit Process

32 Pre-emptive Strikes Proactive Interventions Decorah 400 Bellevue 575 Manchester 220 Coralville 1400 C-Ave 1300 Main Plant 180 Total 4075

33 Claims vs. Interventions WC Claims vs. Pro-Active Interventions Claims Pro-Active Interventions

34 Wellness

35 Health Promotion

36 122% increase in participation over total participants for ,283,664 total minutes of logged exercise 64,183 miles walked with total minutes of exercise converted to miles walked at 3.0mph Health Promotion

37 Health Promotion

38 Atlas Site Biometrics Biometrics 2013 Participation 2014 Participation # MD Referrals Percent Participants with a MD Average BMI # Coached referral (any metric) Percentage Coached # Engaged Percentage Percentage # Rechecked Engaged Rechecked ATLAS TOTAL % % % 80 2% Charlotte % % 16 11% 4 3% Chicago % % 42 30% 7 5% Dallas % % 26 27% 4 4% Edwardsville % % 52 38% 7 5% Elwood % % 16 10% 12 7% Gary % % 72 40% 3 2% Green Bay % % 67 3% 27 1% Indianapolis % % 62 18% 9 3% Marion % % 48 60% 6 8% West Memphis % % 11 11% 1 1% Fontana (Mail Kits & MD Reports) % % 0 0% 0 0% Carlisle (Mail Kits & MD Reports) % % 6 1% 0 0% Participant: Associate who participated in the biometric screen Coached: Associate who particiapted in an intitial coaching session (typically during the intial biometric screen) Engaged: Associate who participated in an additional coaching sessions beyond the initial incentive screen encounter. Rechecked: Associate who returned for a non-incentive biometric screen, within the same incentive year.

39 Critical Read Dee W. Edington Health Management Research Center University of Michigan March 2009

40 Q Wellness Outcomes Total Number of Recheck Screens in the Quarter: 51 Number of screens demonstrating a health shift: 15 Transition of Risk High to Low Risk Low to High Risk Factor per Participant $3,301 $3,301 Factor per Participant Number of Participants 2 0 Number of Participants Estimated Savings $6,602 $0 Estimated Cost High to Moderate Risk Moderate to High Risk Factor per Participant $2,764 $2,764 Factor per Participant Number of Participants 6 1 Number of Participants Estimated Savings $16,584 $2,764 Estimated Cost Moderate to Low Risk Low to Moderate Risk Factor per Participant $537 $537 Factor per Participant Number of Participants 4 2 Number of Participants Estimated Savings $2,148 $1,074 Estimated Cost # Participants Improved 12 3 # Participants Worsened Total Estimated Savings $25,334 $3,838 Total Estimated Cost Net Savings: $21,496 Quarter Wellness Cost Savings

41 Archives of Internal Medicine 2007; 167;

42 Claim Costs / BMI Cost of Medical Claims vs. BMI $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 < > 40 BMI Archives of Internal Medicine 2007; 167;

43 LWD per Claims / BMI Lost Work Days / Claim vs. BMI Days < > 40 BMI Archives of Internal Medicine 2007; 167;

44 Short Term Disability BMI vs. Short Term Disability Among Employees Odds Ratio < >30 BMI Archives of Internal Medicine 2007; 167;

45 Workplace Injuries BMI vs. Acute Traumatic Workplace Injury Odds Ratio BMI Archives of Internal Medicine 2007; 167;

46 BMI Tables

47 BMI Tables

48 Indemnity Claims Costs Measure Normal Weight Obese Class III % Increase Per 100 FTE's Medical Claims % Medical Claims Costs $7,503 $51, % Lost Workdays % Indemnity Claims Costs $5,396 $59, % Archives of Internal Medicine 2007; 167;

49 Key Strategy Wellness

50 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

51 Early Intervention Know when to call a duck a duck...

52 Early Intervention All Associates Injury Screens: 490 *Est. Direct Savings Per Screen: $1,128 Injury Screen Savings: $552,720 * Reference: Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatmentand Cost-Effectiveness of Early Intervention for Acute Low-Back Pain Patients: A One Year Prospective Study. J Occup Rehabil. 2003;13(1):1-9. Survey Injury Avoidance Cost Savings (Injury screens include surveys and walk-in associates)

53 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

54 Ergonomics Risk Analysis

55 Ergonomics Risk Analysis

56 Risk

57 Exposure Strain Index REBA WISHA Push Pull Carry Risk

58 Risk

59 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

60 Rehab Services Program Philosophy Exercise Stabilization training Aerobic conditioning Balance / coordination Strengthening Mobility/ stretching Education Relationship to work activities

61 CPT Code Billing vs. Hourly Rate Consider Your Pricing Model

62 Physical Therapy Savings Carlisle Charlotte Dallas Edwardsville Fontana Gary Green Bay Indy West Memphis Reg. CPT Code-based PT: Hourly Rate-based PT: $16,537 $22,148 $32,826 $19,692 $27,730 $26,716 $217,997 $7,646 $15,967 $6,602 $4,429 $5,802 $4,001 $5,475 $5,148 $43,557 $1,340 $3,676 Savings or Loss: $9,935 $17,719 $27,024 $15,691 $22,255 $21,568 $174,440 $6,306 $12,291 Total Quarter Savings: $307,226 Quarter PT Cost Savings

63 More Perverse Motivators

64 More Perverse Motivators

65 More Perverse Motivators

66 Physical Therapy Savings Carlisle Charlotte Dallas Edwardsville Fontana Gary Green Bay Indy West Memphis Reg. CPT Code-based PT: Hourly Rate-based PT: $16,537 $22,148 $32,826 $19,692 $27,730 $26,716 $217,997 $7,646 $15,967 $6,602 $4,429 $5,802 $4,001 $5,475 $5,148 $43,557 $1,340 $3,676 Savings or Loss: $9,935 $17,719 $27,024 $15,691 $22,255 $21,568 $174,440 $6,306 $12,291 Total Quarter Savings: $307,226 No motivation to do more. Provide the right level of resource to effectively get the job done.

67 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

68 Injuries will happen, then what

69 We need to solve for the disconnect

70 Measurement of Essential Functions The Job and its Essential Functions Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands Single Tasks Critical Demands

71 Job Demand Analysis

72 Interventional Matrix Case Management Return to Work Evaluation Rehab Services Recordable Event Reactive Ergonomics Employee Triage Discomfort Pro-active Ergonomics & Wellness Pre-work Screens Essential Function Profiles of Jobs

73 Case Management Employee Providers Employer

74 Focus on the desired outcome from the onset of the injury open communication at all levels Employer Employee Physicians Therapist Case Managers Case Management

75 Case Management Track and report on the probable outcomes

76 Track and report on the probable outcomes Incidents & Near Misses Case Management Identify Premier Providers Track outcomes and actions

77 Interventional Matrix Case Management Return to Work Evaluation Data Flow Rehab Services Reactive Ergonomics Recordable Event Employee Triage Pro-active Ergonomics & Wellness Discomfort Pre-work Screens Essential Function Profiles of Jobs

78 Questions Drew Bossen, PT, MBA 4191 Westcott Drive NE Iowa City, IA Phone: Fax: