Physical Therapy Utilization in Workers’ Compensation: The Role of ODG and Confounding Factors

Physical therapists play a crucial role in the recovery and restoration of function for injured workers. They are also key players in the role of optimal and effective management of visit utilization. As the workers’ compensation industry continues to strive for high- quality outcomes while containing costs, utilization visit management remains a key focus.

Proactive and effective utilization visit management does not just lead to cost containment but also helps the injured worker achieve the quality outcomes they need through quality, timely, and evidence-based care.

What are the Official Disability Guidelines?

The Official Disability Guidelines (ODG) are evidence-based treatment guidelines that help to standardize care in the industry. It helps guide medical treatment decisions, can be used to determine any need for utilization or peer reviews by payers, and can facilitate return-to-work planning as well as claims management. The guidelines can also serve as a benchmark for the clinician to work from on each claim. They also provide a framework for physicians, physical therapists, case managers, and payers to collaborate in order to align on goals.

Not all claims are straightforward. Claims involving injured workers with confounding factors can potentially complicate the clinical picture and can require an even more focused approach to clinical care. Confounding factors are variables that have the potential to complicate the recovery process and length of time needed for treatment. Confounding factors include conditions such as obesity, diabetes, hypertension, depression, anxiety, legal representation, and many others.

Occupational demands can also influence the amount of care needed. For example, an injured worker with a sedentary job may not require the same number of visits as a construction worker with the same injury, due to the physical demands required to perform job duties. The communication pathway between physician, clinician, case manager, and payer becomes even more important in cases with confounding factors, to ensure the injured worker receives the best possible outcome in the most efficient and timely manner.

Putting It into Practice

At Athletico, we have incorporated the ODG guidelines for each work comp case into our practice management system. This allows the treating therapist to see the ODG benchmark specific to each case. At the initial visit, the therapists also capture comprehensive information related to the injured worker’s case, including job demands, physical demand levels, and any confounding factors that the injured worker may have.

This enables the therapist to proactively and comprehensively develop a treatment plan and functional return –to-work goals tailored to the injured worker. This helps the injured worker achieve the best possible return-to-work outcome while ensuring the most efficient use of physical therapy visits. This information also enables the clinician to initiate the communication process early with physicians, case managers, and payers regarding an aligned plan for optimal outcomes.

Creating a Comprehensive Care Plan

ODG provides a valuable clinical benchmark and framework for evidence-based clinical care. If there are confounding factors in a case, they are important to identify early so that the treatment plan for the injured worker is comprehensive and proactive. Early communication with referral sources is also important to align on a plan for care. At Athletico, we are focused on delivering in these areas to achieve the goal of having the best possible outcome for the injured worker. Learn more about our workers’ compensation services and connect with one of our licensed experts today.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.