By Larry Regnier
In my career in Occupational Health, two discussions stand out as my least favorite ones to have and both involve Physical Therapy, either an upset EHS manager or Administration questioning referral numbers. Occupational Health and work injury treatment will always be connected to Physical Therapy; however, the relationship is unique, to say the least.
OSHA describes any new stretching or flexing recommendations as well as hands-on Physical Therapy as treatment and therefore recordable. This causes a nightmare for Occupational Health to refer to Physical Therapy. All our clients are affected, as musculoskeletal injuries make up a large portion of injuries across all industries. As Occupational Health providers, we must learn to navigate First Aid vs Treatment with education for staff and innovation for our clients.
Does this sound familiar? The phone rings and it’s Mike from ABC Steel Inc. on the other end wanting to speak with you and the providers as to why we prescribe so much physical therapy, and do we know that PT is recordable. What Mike didn’t realize was he was correct to some point, while the sign outside the building says Occupational Health most of our providers don’t quite grasp that physical therapy is an OSHA recordable as it is considered treatment.
I remember the conversations and questions of how a Physical Therapist telling a patient to do some stretches to increase range of motion can be counted the same as having surgery. Many of the providers could do a respirator certification and a DOT physical with no issues, but they didn’t know the ins and outs of OSHA recordable and the repercussions of not understanding first aid vs treatment in its entirety.
Someone like Mike who is having to bid on projects and wants to keep his incident rate and OSHA recordable as low as possible is going to be watching every single work status emailed to him. Staff education is paramount to helping providers understand this, so when phone calls like Mike’s occur, they can be prepared. Having a thorough explanation of OSHA recordable including first aid and treatment with its intricacies, restricted work recordable, when stretching is allowed, etc., is essential for client satisfaction. Just having the OSHA “First Aid vs Treatment” document that every occupational health clinic has for reference is not good enough. Better-educated staff can empathize with our contact more and allow for better communication.
My other favorite meeting discussion and that is sarcasm at its best, is being pulled into a hospital administration meeting to be asked why we are not referring more to physical therapy and ortho, as downstream revenue is being reviewed. The hospital administration has no idea that physical therapy is considered a treatment and therefore an OSHA recordable.
We get the painful burden of having to explain that OSHA considers PT as a treatment to hospital administration over and over. Tirelessly trying to make the point as an Occupational health provider we need to keep recordables in check whenever we can and not over-treat. The meeting would end with no action plan but confused looks and the cycle would repeat in 6 months.
What options do we have for creating PT solutions, so we can reduce these types of conversations happening again with Mike and hospital administration? OSHA defines an established stretch and flex plan that is communicated and transparent at a company as first aid. An easy service for physical therapy to add is injury intervention with PTs caring for patients by referring to a company’s established stretch and flex plan. PT would recommend specific stretches to resolve the employees’ strain or sprained body parts. Injury Intervention could be done onsite, in the clinic, or virtually. This service of first aid and follow-up would allow for PT to resolve musculoskeletal issues and educate employees on what they should do to reduce the risk of recurrence, thus being preventative.
For Mike, at ABC Steel, to have this program implemented all he would have to do is have an established stretch and flex program in place. PT could also help with physical demand assessments, worksite analysis, and job description creation. This is needed to make the program more effective and to bring more ergonomics into play. Work with your physical therapy department to create a billing model for these services so they are not as costly as traditional PT.
These services can be billed directly to the employer and therefore no work comp claims will be processed. Injury Intervention will not keep 100% of musculoskeletal injuries out of receiving physical therapy as a treatment, but many mild strains and sprains can be treated this way. Industrial massage is another option that is considered first aid as well that can be performed by PT.
Establishing innovative PT services would also help you in those discussions with the administration. Injury intervention and industrial massage will not only benefit your clients by reducing recordable and helping workers heal quicker but also your company’s bottom line and internal referral volume.
Looking for new growth has always presented a challenge for Occupational Health. Work with your clients and strengthen those partnerships by asking questions and looking for solutions. Goal-oriented, thought-provoking conversations will strengthen relationships and bring about new offerings, better service, and personalized care for your clients and their employees. Lastly, don’t be afraid of piloting new services, so many great ideas are lost in fearing change.
