PT Classroom - 7 Strategies to Improve Your Return-to-Work Rehab Program ׀ by Jim Mecham, MSIE, OTR/L, CPE


Jim Mecham, MSIE, OTR/L, CPE is the continuing education director and software developer for OccuPro. OccuPro has provided private practices with industrial rehab software and continuing education for 10 years. Jim has helped thousands of private practice physical therapy clinics implement high level return-to-work industrial rehab programs. OccuPro’s web based software application is a full return to work testing system and all of OccuPro’s courses can be taken Live in Person or through highly interactive Live Webcast technology. For more information feel free to visit, contact OccuPro at 866-470-4440, or e-mail Jim at

7 Strategies to Improve Your Return-to-Work Rehab Program

Outpatient rehabilitation clinics are penny pinching all over the United States. From healthcare reform, Medicare cuts, and workers’ compensation managed care, reimbursement is falling while a rehab clinics expenses and salaries are rising. It is a scary trend for many rehabilitation directors/owners as they are looking for ways to offset the reduced reimbursement. Everyone is looking at workers’ compensation patient volume/revenue and on-site cash based revenue as the means to offset this trend.

Rehabilitation clinics throughout the country have workers’ compensation initiatives in full force. They are looking at opportunities to enhance revenue with improved clinic based workers’ compensation services and providing cash based on-site services at local employers.

How are you going to accomplish the goal of increasing workers’ compensation outpatient rehab volume which in turn can increase clinic and on-site based revenue streams? Here are seven strategies that work to differing degrees based on your market.

Strategy 1
Train your staff to understand there is a difference between rehabbing a patient and rehabbing an injured worker. The professionals involved in getting an injured worker back to work, including case managers, physicians, claims adjustors, patients, and employers, rarely care what your patients muscle strength and range of motion is. All of these professionals are concerned with how close to return to work your patient is. When you send progress notes on a workers’ compensation patient, and the Dr. has given you the okay to perform strengthening activities, you should be providing all of the entities involved in the case with functional progress notes and functional discharge summaries.

There is very little value in regards to documenting that your workers’ compensation patient has 4+/5 strength and 47 degrees of active range of motion. What the employer, case manager and physician care about is that the patient can perform 45.2% of their job. Then 6-10 visits later they can now perform 63.6% of their job which would suggest they’ve had an 18.4% improvement specifically in regards to returning to the essential functions of their full duty job.

Then when someone is discharging the patient, either the treating physician, case manager, claims adjustor, managed care organization, or whoever, and the client can only perform 73.8% of their job, you have the objective information that suggests that yes, the patient can be discharged from skilled outpatient rehab but they require work hardening, work conditioning, or advanced work rehabilitation.

This strategy turns you into a practice that specializes in the return to work of the injured worker and separates you from the practices that continue to treat injured workers just like any other patient.

Functional progress notes and functional discharge summaries are 15 to 30 minute functional re-evaluations that can be performed every 6 to 10 visits and do not require a physician’s order nor do they require insurance authorization. These testing methods are easy to perform and tend to be performed by all the therapists within an outpatient rehab practice. They are not Functional Capacity Evaluations and most rehabilitation professionals are willing to perform them secondary to their understanding of how important function is.

Strategy 2
If you are looking to rehab your house, would you go to 10 different hardware stores to find the material you need or would you go to one hardware store that has a full menu of material you need to complete the project. When an employer is looking to work with an occupational medicine Dr. do they choose the doctor that just does drug screens and physicals, no they choose the Dr that has a full menu of occupational medicine services

Same thing holds true for when a Dr., case manager, claims adjustor, or employer directs care for rehabilitation. They want the injured worker to go to a rehab practice that has a full menu of return to work services.

If you only provide outpatient rehab and even if you are the best therapist it does not matter, they are going to send the patient to the return to work specialty practice that focuses on return to work function and provides Functional Capacity Evaluations, Functional Progress Notes, Functional Discharge Summaries, Work Conditioning, Job Analysis, On-Site Rehab, On-Site Injury Prevention, Ergonomic Consultation, Back School classes, Post Offer Employment Testing or other return-to-work/stay-at-work/injury prevention services. Why, because they will choose to send the clinician to a practice that has a full menu of services.

Strategy 3
Putting together marketing collateral can have some nice benefits but any marketing material needs to talk about your full menu of return-to-work services as well as your on-site preventative/reactive services. Also make sure that your marketing collateral talks about your specialty in treating the injured worker and getting them back to work as soon as functionally possible. You need to promote how your return to work rehab clinic is different than the clinic down the road from you.

Everyone does Functional Capacity Evaluations and work conditioning so this will not separate you. Separate yourself from your competition by showing off your return-to-work functional documentation and the progress notes you perform during outpatient therapy. Make sure your marketing strategies point out that you will send this documentation directly to the employer while their employee is in rehab. What about HIPAA? HIPAA is slightly pushed to the side as long as your documentation is prudent and focuses on your patient’s ability to perform, or not perform, the essential functions of their job and yes you can communicate with the employer.

Strategy 4
You communicate with the treating physician pro activity, why not communicate verbally with the case manager, claims adjustor and employer. Many of the leading return-to-work rehab clinics throughout the United States perform the following steps upon getting a referral for rehab from a workers’ compensation patient.

1) Receives referral from physician office or patient
2) Contacts insurance to verify if it is an open and active workers’ compensation claim
3) Obtains verbal authorization for therapy
4) Once verbally approved, informs person on phone that they will next be contacting the employer to obtain the job description
5) Same person contacts the employer and introduces themselves and the practice in the following way, “Good morning, this is Barb and I am calling for ABC Therapy. We are an outpatient rehabilitation practice that specializes in getting the injured worker back to work as quickly and as safely as possible. I was hoping you could fax me Mr. Smith’s job description so we can set long term goals that directly focus on the essential functions of Mr. Smith’s job?”

This is a great soft sell to employers every time one of their employees enters your rehabilitation practice. If there is no job description maybe this is your opportunity to go on-site and perform a Job Analysis and write up a job description.

Strategy 5
Workers Compensation managed care is taking over the landscape of workers compensation rehabilitation. If you sign a contract with managed care you are not guaranteed you will get any patients. Many hospitals and physician owned therapy practice avoid the workers’ compensation managed care contracts because they have a direct referral source in-house. Either way they are also implementing strategies to offset reimbursement decreases from other insurance avenues through workers’ compensation initiatives.

No matter how you get your referrals, this strategy helps to increase workers’ compensation referrals and also helps to establish cash based on-site services at local employers.

You have a physician’s order that says 3 times per week for four weeks. Take one of those visits and take the patient to their job while you perform a Job Analysis. You do not need a doctor’s order nor do you need insurance approval to do a Job Analysis. All you need is permission from the employer to step foot on their property. The patient will not perform their job but you and the patient will watch someone else doing their job while you take notes on the physical demands required for full duty return to work. The cpt code you use is 97537 for each 15 minutes you are on-site with the patient. Use this data to perform improved functional return-to-work rehab, establish long term goals that are functionally based, and test the person using functional progress notes and functional discharge summaries. After this visit to the company, write up a job description whether the company wanted it or not and contact the company representative afterwards and offer to come in to show them the job description you wrote up. This strategy more often than not lands you a contract to re-write all of their job descriptions.

This is a great soft sell to the employer, allows you to meet the decision makers for on-site cash based services, helps to break the psychosocial barrier of return to work, but most importantly tells local industry that you are that markets specialist in return to work of the injured worker because you take the extra step to know exactly what the patient needs to do for full duty return to work.

Strategy 6
When done correctly, work conditioning, work hardening or advanced work rehab continues to be one of the best reimbursed services in 80% of the United States. Case managers consistently direct care to these programs. However, they direct care to programs that successfully get the injured worker back to full duty work.

To increase referrals into your work conditioning program and to decrease denials from the insurance company, you need to communicate proactively to the case manager during outpatient rehab. This includes proactively letting the case manager know that you feel the patient may need work conditioning. Make sure your communication outlines the exact return to work function the client can and cannot perform related to the physical demands of their job. If your patient can only perform 73.8% of their job at discharge from outpatient rehab then they require work conditioning.

Strategy 7
We will call this a strategy but it is the strategy that has the least effect on your workers’ compensation referrals. This is marketing directly to the Doctors. Whether it is marketing collateral or going to visit the Doctor on a marketing call. It is good to let them know you are there, and get to know them, but it is rare that these marketing efforts increase referrals long term. Focus these marketing efforts on what you do different from the clinic down the street. Quality documentation in regards to return to work function is what the Dr’s need to make an objective return-to-work decision

There is no other professional that spends as much time with a workers’ compensation patient as compared to the therapists. A physician sees the patient for 5 minutes and needs to make a return to work decision. You see them for 60 minutes three times a week and have the skills and equipment to make return to work recommendations. It does not require a 4 hour Functional Capacity Evaluation to make return-to-work decisions. An outpatient therapist can do a 30 minute functional progress note or functional discharge summary and provide the physician with objective return to work information every 6 to 10 visits, bill 97750 for this time, and greatly assist the physician with objective return to work information.

Improving workers’ compensation services, offering a full menu of return to work services, functional testing workers’ compensation patients during outpatient therapy, and proactively communicating with all entities involved in the workers’ compensation patient are key strategies to increase referrals and revenue in ever more challenging times for rehabilitation clinics.
Last revised: May 21, 2014
By Jim Mecham, MSIE, OTR/L, CPE

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