On-site PT: Low-cost approach generates high-dollar savings

Early intervention, easy access help cut injuries, boost productivity

On a dollar-for-dollar basis, few work site health interventions can offer more attractive returns than an on-site physical therapy service. While most of the actual cost is borne by the insurance carrier, the employer not only benefits by reducing injuries, but by improving return-to-work rates and saving the travel time hours employees would require to visit off-site services.

"It all comes down to finances," says Marilyn Roofner, PT, director of outpatient rehabilitation at Orlando (FL) Regional Health Care System. Having physical therapy services on site, says Roofner, offers employers these benefits:

1. Control over the rising costs of health care: On-site care assures the earliest possible intervention; the earlier an employee enters the health care system, the less time it takes to become rehabilitated.

2. Decreasing outside visits to medical providers: This includes doctors and therapists of all types.

3. The opportunity to negotiate a better rate: The negotiating provider would be guaranteed to have patients, and will generally commit X hours for X dollars ($50-$60 a visit is a good rule of thumb). With office visits, on the other hand, the employee must pay the prevailing payor rate.

4. Decreased litigation risks: An employee who gets early intervention feels (and is) well cared for, and is less likely to sue the company.

5. Greater control over providers: The company is going to pick the providers it believes provide the highest quality of care. There is also immediate and constant communication between the employer and the provider.

6. A decrease in indemnity, or indirect costs: These are costs not directly associated with treatment, such as the time lost when employees go off-site to see a doctor.

A long-standing commitment

One company that has reaped the benefits of an on-site PT program is New Brunswick, NJ-based pharmaceutical manufacturer Bristol-Myers Squibb Co. The firm has a long-standing commitment to on-site PT, having started its program in July 1992.

"Like most other companies, we had seen a significant increase in upper extremity repetitive injury — in fact, we had had a tenfold increase over the prior decade," recalls Joseph Ferro, MD, senior medical director. "We thought one of the most important ways [to cut costs] is by early recognition of symptoms, early intervention, education and ergonomic evaluation. And we’ve found that through physical therapy we were able to do all of those in a very cost-effective manner."

How effective is early intervention? Ferro says the average amount of lost time for carpal tunnel syndrome is about 30 days, based on figures from the U.S. Department of Labor. "For us, the vast majority of cases don’t have any days out. As soon as symptoms develop, we will do an ergonomic evaluation and set up an on-site PT appointment." During those appointments, the employee will receive therapy, exercise, and education.

Sometimes, Ferro says, nurses will recognize symptoms even before the employee feels there is a problem. "Our nurses are very much in tune to symptoms, because early recognition is critical," he says.

The Bristol-Myers Squibb facility is open two days a week, from 7:30 — 9:30 a.m. An outside physical therapy service comes on-site, and sets up in a room provided by Bristol-Myers.

Utilization is managed through a physician referral process. "We have three board-certified internists who oversee utilization," Ferro explains.

Roofner notes that the utilization process is often governed by state law. For example, Florida law permits direct access. "A person can go to a PT without a doctor’s referral; he can just show up at the office," she explains. "But, the insurance company won’t pay for it unless you have gone through the proper route. We’ve developed a protocol with the company physician, so that we are all in agreement about exactly when the employee will be referred to a doctor."

At Bristol-Myers, if the injury is work-related, the workers’ comp carrier pays for it. "It has been so successful, we brought it on for non-occupational injuries," Ferro adds. In those cases, the employee’s insurance company pays for the treatment.

Savings are impressive

Companies who have used on-site PT services report significant savings. "Our most impressive was in carpal tunnel," notes Ferro. "According to the Department of Labor, each injury costs $3,000 — $30,000 if surgery is required. Three years prior to instituting our program, we had 12 cases, all of which required surgery. Since 1992, we have had a total of three surgical cases (of 22 total carpal tunnel cases), and two of those were due to anatomic malformations."

Even when there is an injury, he notes, savings are significant. "If you just look at the $3,000 average cost per injury, if there are six visits at $50-$60 a visit, that’s one-tenth of the typical cost," he says.

Bristol-Myers has carefully tracked these costs, Ferro notes. "We even broke them down into both back and upper extremity injuries, and compared the duration of on-site treatment with the average time required for off-site treatment," he says.

For back injuries, for example, Bristol-Myers has averaged anywhere from four to five days of on-site treatment, versus a 17- day national average for off-site treatment. For carpal tunnel, the figures are six days on-site, and 20 off-site. (See p. 136 for a table illustrating other results of Bristol-Myers’ experience.)

"And for us, the greatest savings are not even represented by those [statistics], but by the drop in absenteeism and a reduction in suffering for our employees," Ferro says.

Roofner, whose clients include major entertainment firms like Walt Disney and Universal Studios, as well as Lockheed-Martin and Frito-Lay, says many employers have reported significant savings using on-site therapy. "We just got a report from one of our accounts who had a 40% decrease in OSHA reportables (injuries requiring off-site treatment; OSHA uses these figures to measure the injury frequency of a particular employer in a given year.)

Why is this significant? "If an employer’s reportables rate is very high, OSHA will pay you a visit — and this will influence your insurance rates," Roofner explains.

Another client of Roofner’s completed a two-year study after instituting on-site PT services and a certified personal trainer. "They had a 50% decrease in the reported number of sprains and strains and a 66% decrease in workers’ comp costs," she says.

Still another company, in a three-year study, reported that on-site PT services resulted in a decreased frequency of injury rate per 1,000 employees, from .15 to .094.

Not everyone goes on-site

Some employers choose not to go the on-site PT route. At the Orlando Sentinel, for example, employees go off-site for therapy. However, they do participate in a "defensive back" program provided by Roofner’s staff. "They come on site and evaluate each job, and put together a training program for each area," explains Bonnie Orban, the newspaper’s workers’ compensation manager.

The detailed program includes pictures of work locations, and job descriptions. "They will even weigh boxes, paper, and look at the type of shoes people wear," says Orban. The program also includes education classes on topics such as proper lifting techniques.

The program has clearly worked. "Our back injury rate has decreased significantly," Orban notes. "We have one or two a year, compared with years past when there may have been 10 or 20."

Why doesn’t the newspaper offer on-site services? "We just don’t have the room," Orban says. "For our more remote locations, it would be an advantage because of the considerable distance and time lost traveling."

Providing both prevention and treatment is the ideal approach, says Roofner. "You can’t do one [treatment] without the other [injury prevention]; we would be failing to do our duty," she says.

Susan J. Isernhagen, president of Isernhagen Work Systems, a Duluth, MN, international consulting firm for work injury management and prevention, agrees. "Our task goes way beyond treatment," she says. "One of the problems we’ve seen with both on-site and off-site services is that there needs be more job analysis, and more attention paid to prevention, where you can save a lot money."

After an injury has occurred, if you don’t treat the individual and the job, "The employee has a higher potential of being injured a second time, and the costs to the employer are substantially more," she adds.

All things being equal, however, the on-site approach is the way to go, and as Ferro notes, cost is not a problem. "If you have the space and you have a therapist who is willing to come out [to the worksite], and you have the volume [of patients], there really is no expense," he says. "The insurance companies are very happy, because they have seen the statistics that show on-site services dramatically lessen duration of injury. And the employees are very glad have a service that is so convenient. From a productivity standpoint, it is just tremendous."


Marilyn A. Roofner, Orlando Regional Rehab Services, 2711 West Fairbanks Ave., Winter Park, FL 32789. Telephone: (407) 647-6649. Fax: (407) 644-2093. E-mail: mroofner@orhs.org.

Joseph Ferro, Bristol-Myers Squibb Co., One Squibb Drive, New Brunswick, NJ 08903. Telephone: (732) 519-2000.

Bonnie Orban, Workers Compensation Manager, The Orlando Sentinel, 633 North Orange Ave., Mail Point 86, Orlando 32801. Telephone: (407) 420-5225. Fax: (407) 420-5766.

Susan J. Isernhagen, Isernhagen Work Systems, 1015 East Superior St., Duluth, MN 55802. Telephone: (218) 728-6455.