Jordan Mackner 2014-07-26 00:23:52
Conservative Care Following a Work Injury or Accident: How Much is Warranted? Almost always following a work comp or accident injury case there will be some sort of conservative care warranted for the patient. Most commonly, this care will involve chiropractic care, physical therapy, passive modalities, active care and other conservative approaches such as anti-inflammatories. With this in mind, I’d like to note the seemingly continuous out of control nature of these treatment plans. High patient visits aren’t accompanied by increasing improvement; rather little improvements are being seen. This situation results in lowered standards of care and promotes patient dependence on the provider. It also shoots the health care costs through the roof. So, how do we spot provider abuse in this situation? And, how do we know if continued treatment is warranted? If you look up almost any musculoskeletal injury in the literature very rarely do you see treatment plans that exceed 10 visits in nature over an initial timeframe of eight weeks (assuming the patient is not post-surgical). This is a good place to start as initial treatment plans should not be prescribing 20-30 or more visits right off the bat. Once the patient is through the initial treatment plan continued visits may be warranted. But how do we tell? Well, the patient must have documented improvements in function, activities of daily living, and subjective pain scale ratings throughout the previous treatment plan. Conservative care should also be allowing the patient to transition into active care and make advancements in a home exercise program. Some providers have caught on to this and started documenting patient improvements in their notes and began requesting more care stating that since the patient has improved more care must be warranted. Not so fast. The key here is that the patient must be showing continued improvements throughout the treatment plan. So, if the provider keeps stating that the patient could not brush their hair because of a previous shoulder injury and now they can raise their arm high enough to brush their hair and they state this continually every visit then there is not continued improvements seen with care. Pertinent questions in this situation include: • Is there documentation of continued improvements? • Has the patient returned to work? • Is there a weaning of conservative care down to once a week or every other week? • Is there a transition to an at-home exercise program? • Is there progression in the patient’s exercise program? If the provider does not document any of these things and continues to promote the standard two three visits per week on a continual basis then all of a sudden their actions become obvious. The bottom line is that if the patient has progressed throughout the initial treatment plan and assuming the initial plan was a proper length in nature then more treatment is warranted. Another six-eight visits would be a reasonable request. If not, then a change in treatment strategies (i.e., different provider or more aggressive care) or analyzing if the patient is permanent and stationary or has reached MMI is necessary. Dr. Jordan Mackner is a board certified chiropractor specializing in musculoskeletal injuries of the spine, extremities and sports rehab. Dr. Mackner is also certified by the Arizona Board of Chiropractic Examiners in physiotherapy. To complement his clinical practice Dr. Mackner performs utilization review on disputed medical cases in California and he also focuses his practice on independent medical examinations for workers’ compensation cases and personal injury. He currently holds an active chiropractic license in Arizona. For more information or to get in touch with Dr. Mackner, please feel free to call ExamWorks at (866) 800-4637.
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