Cost driver in focus: Excessive physical therapy

Excessive use of physical therapy can be a significant cost driver for workers compensation payers and can impede return to work, according to a recent study.

“Physical therapy is a wonderful thing; it’s just when it’s abused,” said Dr. Ed Bernacki, a professor of population health with the Dell Medical School at the University of Texas at Austin, who co-authored a study finding that the costs associated with 15 sessions or more of physical therapy can be close to double the costs of 10 to 14 visits.

The study, published in August’s Journal of Occupational and Environmental Medicine, provides data sourced from 192,197 comp claims in Texas between 2013 and 2017 and concludes that 15 or more visits for an injured worker can increase claim costs more than other common cost drivers such as comorbidities, opioid use and legal involvement.

Specifically, researchers found that the average indemnity for nonsurgical claims with 15 or more sessions was $19,013 — nearly $10,000 more than the next costliest category of those with 10 to 14 visits. Average medical costs for those in the 15-plus category stood at $18,494 — $10,000 greater than the average cost in the 10-to-14 category, according to the study.

Surgical claims with more than 15 physical therapy session cost the most, with a combined indemnity and medical average of $71,014, which was $31,627 more than that of the next highest category of 10 to 14 visits, according to the study.

Researchers also found that 15 or more physical therapy sessions was a “better predictor” of lost time in excess of six months.

“There are parts of the system that are broken,” said Jeff Weeks, partner and chief development officer at ARC Physical Therapy+ in Overland Park, Kansas, whose business is 60% comp patients and believes unscrupulous practitioners are a concern. “You should have a pretty good idea of what the prognosis is on the third or fourth visit (of physical therapy), but not all operate as such.”