Run of the mill
We’ve all seen it. Initially, after the injury, the injured worker (IW) goes to their PCP or occ. health provider and is sent to PT for their back, ankle, knee/shoulder complaints. The Provider completes the examination: PT is ordered 1 month to 6 weeks followed by a recheck. With no improvement in 4-6 weeks, the provider recommends an MRI and lo and behold, there is a tear in the meniscus or rotator cuff or whatever site, which needs surgery. Pretty commonplace stuff.
The algorithm used in this case, for WC, is consistent with the one utilized by health care providers for non WC claims/ injuries. Having been a case manager for almost 25 years, I’ve seen a slow change toward getting the diagnostics done up front to determine if there is a repairable tear or lesion rather resorting to knee jerk (no pun intended) physical therapy for a month to six weeks, revisit the Provider and then, with no progress, order the imaging.
Proactive & Aggressive
A Third Party Administrator (TPA) for whom I do considerable case management with has authorized me, on their behalf, to authorize diagnostic imaging within the first 2 appointments, given the presence of key symptoms or signs. There are three advantages to this approach,
- The Case Manager is in the examination office, with IW assent
- The cost savings are the cost of an MRI or one month’s cost of PT.
- With imaging completed, there is a baseline set of images of that particular body part should repeat diagnostic imaging be required later on, for either this claim or a subsequent claim.
If the diagnostic imaging comes back with a surgical solution, surgery can be scheduled promptly. If the diagnostic imaging comes back negative for anything surgical, aggressive PT can begin, because the PT and IW know there is no surgical intervention indicated. Perhaps, on the job work hardening is indicated. The Employer might be more willing to have the IW RTW on transitional duty, knowing the IW has sprained/ strained a body part and does not have an issue needing surgical intervention.
pushing from every avenue & every angle
The early diagnostic imaging brings peace of mind to the provider, IW, TPA carrier and ER. Early RTW limits indemnity payments and the IW gets to resume their productivity and maintain their self worth, providing for their family, the Employer is happy; work is being done