Utilization
What is utilization?
What is the access expectation for a WC patient?
24-48hrs
When should you contact the nurse case manager?
After IE
Any yellow/red flags
Cx or No show
Prior to MD visits
What does ODG stand for?
Official Disability Guidelines
What is Athletico's workcomp central scheduling called?
WORK4U
What is Athletico's goal for utilization?
19
When do you start a new workcomp case?
Treated for pre-op and then return post-op = new case
Work conditioning
FCE
When should you call the MD?
If patient not progressing as scheduled/expected
Prior to MD follow up visit
Guidance on plan of care
Protocol questions or restrictions
What goes into an FSR?
Floor to Waist
12" to Waist
Shoulder Lift
Carry
How do you identify a patient who has plateaued?
Good effort but not progressing (Strength, ROM, weights)
Therapist has attempted to functionally progress patient (FSRs)
Patient has had adequate medical care
Why is utilization important?
Primary factor for networks and employers to decide PT providers
# of lbs a WC patient should increase per week
10lbs/wk
How often do you do an FSR?
Every 2 weeks
What is considered a Medium PDL?
What is the goal for coding (QCU)?
5.5 or above
What is the avg utilization for non WC patients?
12-13
How often should you increase load and reps for a patient in strengthening phase?
Every freaking day
When do you recommend work conditioning?
PDL of heavy or very heavy
Greater than 3 months off work
Patient likely RTW just needs onramp (conditioning)
Why would you recommend an FCE?
When discussed with NCM/MD and all are in agreement
Questionable effort
Patient has plateaued-PT no longer indicated; may need work restrictions
Where can you find job descriptions?
Employee Portal --> Workcomp --> Clinician WC resources
Call NCM
How do I handle a physician who keeps writing a script despite patient meeting job demands and we recommend DC?
Group Discussion
True of False: Higher frequency leads to higher utilization
False
When should you recommend discharge?
Majority of essential functional goals met
Patient has plateaued
Patient is non-compliant
What is the FPS?
Functional Pain Scale
When do you send cancellation notes
Every cx or same day reschedule