Leveraging the Value of Onsite Early Intervention Services with Employers

Looking to expand your services and revenue potential beyond the traditional insurance model? My practice hasn’t billed an insurance company in 15+ years. I don’t have a brick-and-mortar clinic. All of the services we provide to employers are conducted onsite. The opportunity to provide direct-to-employer services has never been greater! Employers can no longer ignore, avoid, or dismiss the musculoskeletal health of their workforce. Early Intervention (EI) programs are a highly effective safety strategy for mitigating soft-tissue injuries while also promoting the overall musculoskeletal health of a workforce.

Employers and Musculoskeletal Health

Employers are consistently facing spiraling healthcare and disability costs - particularly with musculoskeletal conditions. Additional challenges include worker recruitment/retention, an aging workforce, and corporate expectations of a “zero injury” safety performance.1-3 Savvy employers focus on Total Worker Health® initiatives that integrate a holistic model for improving workforce safety, health, and well-being. Physical therapists with expertise as Occupational Health practitioners are uniquely positioned to assist employers in addressing these challenges as entry-point practitioners, as evidenced by APTA’s position statement (HOD P08-22-12-14 [Position]).4

Musculoskeletal disorders (MSDs) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Employers spend billions of dollars annually on MSDs due to factors such as absenteeism, lost productivity, disability, and worker’s compensation costs.5 The total cost of a single “sprain & strain” injury can range from $40k to >$100k.6 Epidemiology studies demonstrate that MSDs are multifactorial, which is why employers often find it difficult to identify a specific “root cause” that created an injury.7 The early warning signs of MSDs are usually present long before the employees experience a level of pain and loss of function that requires medical treatment beyond first aid interventions. These early warning signs commonly include reports of discomfort, achiness, soreness, stiffness, weakness, and intermittent tingling/numbness.

The Onsite Early Intervention Model

Early intervention (or Industrial Athlete programs) is a proactive strategy that addresses the early warning signs of MSDs, identifies potential root causes of discomfort, and prevents symptoms from progressing into an injury using OSHA-approved first aid interventions.8,9 The EI process empowers employees to advocate for safety and injury prevention. Early intervention providers triage workers' reported symptoms and identify interventions that address their findings using OSHA-approved first-aid treatments. Treatment examples include hot/cold therapy, non-ridged support (elastic bandages, wraps, back belts, etc), soft tissue massage, kinesiology taping, and exercises included in a wellness program or daily stretching routine.10 Follow-up “contacts” occur weekly or bi-weekly to reassess the employee’s symptoms and monitor recommended changes to the job. This spares the worker unnecessary lost time or suffering and can provide cost savings for the employer by preventing OSHA recordable incidents.

Metrics Matter

Successful EI providers must implement a systematic process that streamlines the management of EI cases and also generates meaningful reports based on EI activity to employer clients. Without an EI program and related data, employers would have limited means of gaining insight and access to the musculoskeletal health of their workforce. Here are a few key metrics that demonstrate value to employers:

• Identify the Total Cost of an MSD injury for your employer client. Demonstrating the ROI of any intervention or service is impossible without knowing the cost of a single MSD to an employer client. Be sure to include both direct and indirect costs. Take it a step further by factoring in the employer’s profit margin (ie, how much additional product the employer has to sell to cover the cost of one MSD). OSHA provides an online calculator that employers can use to estimate the cost of an illness or injury (https://www.osha.gov/safetypays/estimator).6
• Provide Weekly “EI Activity” Summary Reports. The EI service provider must establish a process that captures several key data elements associated with EI Cases. This information can then create a “Weekly EI Activity” summary report for the employer. Data points should include case demographics, symptom information, type of injury, injury mechanism, body part(s) involved, department, job/task, and type(s) of interventions provided. We use a color-coding system (red/yellow/green) that identifies each EI case's level of concern/severity. Safety managers can then focus their attention on the employees with greater concern.
• Quarterly/Annual Performance Reports. Quarterly or annual summary reports help an employer identify trends, patterns, and predictive analytics regarding the health and safety of their workforce. Information of this nature can also assist an employer in understanding underlying causes better and implementing preventive measures that focus on reducing injury risk, as well as identifying opportunities for promoting the musculoskeletal health of their workforce. Data elements include the Number of New EI Cases, the Total Number of EI Cases, the Number of Resolved Cases, the Number of Cases Referred Out for further medical assessment, and an ROI/Cost Avoidance calculation.
• Key Performance Indicators (KPIs). Employers prefer to see their data summarized into meaningful categories. They use the data from an EI program to establish and monitor Key Performance Indicators specific to their health & safety efforts. Data are specific to department areas, total number and types of ergonomic interventions, types of injury, and body areas. This data provides the employer with greater insights into target interventions such as a workplace stretching program, ergonomics, and employee awareness training.

Summary

The burden of MSD injuries continues to be a challenge for employers and their employees. Physical Therapists are uniquely positioned to address this challenge through onsite EI programs. Successful EI providers must use processes that effectively manage EI cases and prove results. Appropriately structured EI programs capture critical data elements that can be used to determine an ROI and reveal opportunities that fuel an employer’s safety performance, generate employee engagement, promote musculoskeletal health, and reduce injury risk.

References

1. Chari R, Chang C-C, Sauter SL, et al. Expanding the paradigm of occupational safety and health. J Occup Environ Med. 2018;60(7):589-593. doi:10.1097/jom.0000000000001330.
2. NIOSH. Fundamentals of Total Worker Health® approaches: Essential elements for advancing worker safety, health and well- being. DHHS (NIOSH) Publication No. 2017-112. December 2016. doi:10.26616/nioshpub2017112
3. Molocznik J. Getting started with Total Worker Health. Professional Safety. 2024;69(1):46-47.
4. American Physical Therapy Association. Access to physical therapists as entry-point practitioners for activity participation, wellness, health, and disability determination HOD P08-22-12-14 [Position]. Accessed April 24, 2024. https:accesstoptsasentrypointpractforactivityparticipation_hodp08-22-12-14.
5. Liberty Mutual Insurance. 2023 Liberty Mutual Insurance Workplace Safety Index. Accessed April 24, 2024. https://business.libertymutual.com/insights/2023-workplace-safety-index/
6. US Department of Labor, Estimated Costs of Occupational Injuries and Illnesses and Estimated Impact on a Company's Profitability Worksheet, OSHA Safety Pays Program, Accessed April 24, 2024. https://www.osha.gov/safetypays/estimator
7. Bernard, 1997; Buckle & Devereux, 1999; Punnett & Wegman, 2004; Nunes, 2009a.
8. Prall J, Ross M. On-site injury triage by a physical therapist in an industrial setting: a case study. Orthopaedic Physical Therapy Practice. 2022;34(3).
9. Kean M, Blickenstaff C. Perspectives from occupational health and safety management of the value of work-site physical therapy. Orthopaedic Physical Therapy Practice. 2022;34(1):298-302.
10. U.S. Department of Labor, OSHA Record Keeping Guidelines 29[B]1904.7. Accessed April 24, 2024. https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.7
     

Competing interests: Developer of Onsite™, a case management software program for therapists who provide Early Intervention programs to employers.
 

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