The effects of a health provider network on costs

and return to work in the compensable setting

Dr Tania Pizzari
Department of Physiotherapy, La Trobe University
November 2014

latrobe.edu.au

CRICOS Provider 00115M

Healthcare Provider Networks

Preferred provider networks in compensation

Reduce compensation costs

Reduce lost time days and disability duration (Baldwin et al. 2002, Green-

McKenzie et al. 2002, Bernacki et al. 2005)

Maintain client satisfaction (Stephens and Gross, 2007)

High quality, relevant rehabilitation (Waldman, 1996)

Multidisciplinary care or physician-centred management most common

No single allied health discipline network

Purchasing of physiotherapy for compensable clients variable (Grimmer-Somers

et al , 2009)

Limited information on influence of network providers on health

La Trobe University

@DrTaniaPizzari

Physiotherapists in Compensable Medicine

Physiotherapists in compensable medicine well placed to facilitate return to work

Good understanding of workers functional status and requirements of work

roles

Set goals to increase functional capabilities

Influence recovery and self-management strategies

Spend more time with the worker
Appreciation of evidence-based medicine
Improved ability to implement a biopsychosocial approach

La Trobe University

@DrTaniaPizzari

Physiotherapists in Compensable Medicine

In UK physiotherapists recently recognised role in Occupational Health (Chetty 2014)

Meet the physical health needs of the working population

Increase in physical health problems leading to absenteeism

Increasing costs of absenteeism

Purchasing of physiotherapy services in compensable clients variable (Grimmer-Somers

et al. 2009). Quality management of physiotherapy claims.

Preferred providers/ treatment networks

Practice accreditation

Limiting number of treatment / limiting money per claim / differential rates of

reimbursement / fixed reimbursement / co-payments

Clinical guidelines / protocols

Benchmarking

La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program

Implemented by the Transport Accident Commission (TAC) in 2008 to deliver better

health outcomes, efficient management, and improve scheme viability

Trial a physiotherapy network provider model to test the feasibility of establishing

contracts with physiotherapists

Recruited:
Feb 2008

44

Select Tender

Jun 2010

44

Selected by Application

Aug 2011

145

Selected by Application

July 2012

50

Selected by Application

Increased fee (~20%), peer review (monthly tracking sheet).

La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program Day 1 Training

The vision of the Occupational Physiotherapy Program

The compensable environment

RTW and early recovery

Certifying capacity

The effect of practitioners/organisation/environments on RTW

Review of RTW guidelines

Risk of failure to RTW and questionnaires to identify risk

Claims management perspective

Clinical justification

Goal setting and principles of patient autonomy

Maximising RTW and recovery in high-risk cases

La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program Day 2 Training

Triage options for those failing to recover and RTW

Functional restoration as the evidence-based physiotherapy option for high-risk

cases

Definitions of functional restoration

Communication and functional restoration

Setting expectations for the worker, GP, employer

Application of functional restoration

The complex patientcase studies

La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program Ongoing training

1. Return to work as a treatment modality
Identifying and managing high-risk patients
2. Update on provider programme within the scheme, clinical outcomes
Accident compensation act
3. The difficult patient
Clinical reasoning for the occupational physiotherapist
4. Use of database and tracking sheet for compensable clients
Case studies and discussion
5. Evolution of the occupational physiotherapy model
Focus on RTW
Preliminary evaluation of the model
La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program 2011 Training

5.5 hours
1.Clinical Framework
2.RTW
3.Understanding the compensable system

La Trobe University

@DrTaniaPizzari

Occupational Physiotherapy Program Health Benefits

Pizzari & Davidson, 2012
OccPT Mean
Change (SD)

Control Mean
Change (SD)

Mean Diff (95%CI)

RTUA

11.18 (18.1)

1.14 (18.4)

NA

0.027

GPE

0.43 (1.4)

-0.19 (0.68)

NA

0.097

SF-12 Physical

5.37 (7.6)

-0.69 (6.7)

6.05 (1.58-10.52)

0.009

SF-12 Mental

0.16 (8.5)

-0.37 (6.9)

3.85 (-0.97- 8.69)

0.12

Change over time from 3 months to 6 months

Within group significant deterioration in SF-12 mental health in control group over
time

Return to work ceiling effect.

Most participants had returned to work at initial data collection point

La Trobe University

@DrTaniaPizzari

10

Aim

To compare average and median workers compensation claims costs and return to
work rates between injured clients managed by network physiotherapists and those
managed by non-network physiotherapists

La Trobe University

@DrTaniaPizzari

11

Method
Identified and contrasted claims managed by occupational physiotherapists
and non-occupational physiotherapists between October 2008 and March
2012
105 occupational physiotherapy claims
1136 non-occupational physiotherapy claims
Claim criteria:
Received physiotherapy within 90 days of injury
Spent less than 15 days in hospital
No return to work at time of initial physiotherapy

La Trobe University

@DrTaniaPizzari

12

Method

Data analysis:
Independent samples Mann-Whitney U was used to compare groups at
12 months post injury
Income costs
Medical and like
Physiotherapy costs
Chi-square test used to compare return to work rates at 3 months post
injury

La Trobe University

@DrTaniaPizzari

13

Results - Costs
Occupational
Physiotherapy

Non-Occ
Physiotherapy

Mean

Median

Mean

Median

Medical and Like

@ 12 months

$4236

$2429

$5462

$3568

0.02

Income Support

$2846

$1389

$5124

$1902

0.046

Physiotherapy

$1297

$1050

$1405

$1064

0.69

La Trobe University

@DrTaniaPizzari

14

Results - Return to Work

At 3 months 90% of Occ Physio claimants had returned to work compared with 81%
of non-occupational physio claims (p=0.059)

RR = 1.8

1.8 times more likely to return to work by 3 months if an Occ Physio client

At 6 months 98% Occ Physio claimants had returned to work compared with 90% of
non-occupational physio claims (p=0.02)

RR = 3.3

3.3 times more likely to return to work by 6 months if an Occ Physio client

La Trobe University

@DrTaniaPizzari

15

Discussion

Reduced costs and improved return to work in workers treated by Occupational

Physiotherapists

No increase in physiotherapy costs associated with increased fees to providers

Previous evidence of improved health benefits

Aim of the program:

Deliver better health outcomes, efficient management, and improve scheme
viability
Trial a physiotherapy network provider model to test the feasibility of
establishing contracts with physiotherapists

Need to consider costs of implementing, monitoring, evaluating the program

La Trobe University

@DrTaniaPizzari

16

Discussion

Training streamlined in last physiotherapy cohort

Focus on correct certification to facilitate return to work
Accountability for knowing status of certificate
Increased focus on early intervention / acute management
Progressed to the current system:
Early intervention physiotherapy framework

La Trobe University

@DrTaniaPizzari

17

Conclusion

Physiotherapists are key personnel in managing the physical needs of

compensable clients
Physiotherapists are well positioned to certify capacity and facilitate return
to work
Physiotherapy training can further improve health and return to work
outcomes, while reducing costs

La Trobe University

@DrTaniaPizzari

18

Thank you

latrobe.edu.au

CRICOS Provider 00115M