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Top 5% of costliest comp claims eat 25% of PT costs: Study

By Louise Esola 

The top 5% of costliest workers compensation claims account for 25% of total physical therapy costs, with the average cost associated with that top 5% more than five times the average cost, according to a white paper released Wednesday by One Call Care Management Inc.

The Jacksonville, Florida-based managed care organization that serves injured workers used its 2019 database in its study of what it called “at-risk” cases, finding that predictive analytics can help identify such injured workers early in the claims process.

“To date, the inherent problem has been the difficulty in accurately identifying these individuals early enough to develop and implement an intervention plan quickly and change the potential outcome of the injured worker’s treatment,” the paper states. “Historically, these cases were identified as problematic and at-risk only after a treatment plan exceeded the initial guidelines, and by then, it was too late to reverse course.”

By assessing such issues as a claimant’s type of work and medical history, “predictive analytics can identify specific triggers that pinpoint an at-risk case and flag it at the onset of treatment,” the paper states.

“This enables the therapist to create a more proactive approach to their treatment plan.”

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