If you sprained your ankle doing yard work… or bumped your head on the kitchen cabinet…or fell taking out the trash and scraped your knee…
How many urgent care clinic visits would you seek?
Would it be six, seven, eight – or even 11 visits – with an average wait time of one to two hours? I would guess not.
Injured workers are directed to “approved” clinics with the expectation that in visit one or two, the providers will determine with some objectivity if there is an injury, and the extent of that injury based on the alleged cause. We know that the natural process of healing would result in a reduction in symptoms and an increase in functionality over time and at each visit there should be incremental progress towards recovery. This is not what is occurring.
Injured workers are being subjected to egregiously excessive, low-value clinic visits, most for seemingly minor conditions. Put yourself in their place, and question the process from their perspective.
These excessive encounters are increasing injured worker anger and frustration with the system, contributing to delayed recovery, with many ceasing to cooperate, and with some seeking counsel and advice elsewhere.
Excessive, low-value clinic visits are not consistent with evidence-based practice.
“First do no harm” is the core principle in the practice of medicine. Let’s apply that to medical management of injury cases.
So, here are four simple tips for adjusters and case managers to reduce the harm being caused by this trending pattern of practice:
1. Speed up the process. If by visit three, pain levels are not decreasing, and there is not consistent improvement in symptoms and functionality with a decrease in work restrictions, then a change in direction is indicated.
2. Staying at work is a powerful treatment modality more important than physical therapy. Remember: not every injury requires six physical therapy visits. If therapy is indicated, clinic follow-up should be on completion of that therapy. If there is no improvement, a change in direction needs to be considered.
3. Engage in empathic dialogue, timely addressing concerns. Provide consumable information and education to build the relationship and trust.
4. Insist that your clinic physicians and mid-levels use the biopsychosocial model of practice. They need to address comorbidities; work, family, and medical history; inquire when there are time gaps between the work incident and seeking treatment; review photos of vehicles when there is a motor vehicle accident; review the records from prior medical visits – and document progress, or lack there of, and question what else is going on when symptoms are increasing rather than decreasing, and functionality is decreasing rather than increasing.
Doing better for many injured workers begins with simple steps to raise performance expectations and accountability of the medical clinics and other health care providers.
