On-site rehab speeds up employees’ return to work

Therapists focus on what patients can do

Although traditional industrial rehab has been geared toward simulating a work environment in the clinic, some HEALTHSOUTH rehab providers have found that therapists are more successful when they treat the patient in their own work environment.

In addition to seeing what the job really involves, the therapists can look at other factors that may affect the rehabilitation process, such as the injured worker’s relationship with co-workers and supervisors.

"When rehab occurs in the workplace, we can focus on what the patient can do, rather than just giving the company information on what the patient’s limitations are," says Terry Zehnbauer, MS, regional director of occupational health services.

Therapists who work with injured patients on the job can suggest ways the company can accommodate the patient’s limitations, as well as working as a job coach, watching the patient perform, and teaching him or her better methods and better work practices.

HEALTHSOUTH Central Carolinas Rehabilitation Complex in Lancaster, SC, set up a clinic on site at Springs Industries Rock Hill (SC) Finishing and Printing Plant in August 1996.

The company previously had a contract with a competitor for physical therapy but changed to HEALTHSOUTH in order to receive on-site services, says Jan Edwards, marketing coordinator for the hospital.

The arrangement makes it convenient for employees because they don’t have to leave the work site for treatment, Edwards says. In addition, the company saves money on mileage costs (for transportation to a clinic) and on lost work time, she adds.

Edwards opened the clinic at the Springs plant in a 10 x 14 air-conditioned room just off a warehouse that was being used for a fitness area. The clinic was furnished with equipment that was in storage when the corporation consolidated some facilities, she says.

Company provides the space

Plant workers helped move the equipment to the site and made some wooden boxes to hold weights at the plant’s woodworking shop.

HEALTHSOUTH is staffing the clinic as much as three times a week depending on the number of patients and their needs. So far, the biggest volume has been three workers who received a total of eight treatments a week, Edwards says.

The HEALTHSOUTH physical therapists who staff the Springs clinic treat inpatients and outpatients at hospital facilities most of the time.

They received special training in industrial rehabilitation before the program began.

The Rock Hill facility is one of Springs Industries’ smallest work sites. The company is considering contracting for on-site physical therapy at its largest locations, based on the success of the pilot project, Edwards says.

"We’ve had a lot of feedback from the employees, the company, and the therapists. The therapist are able to visit the job site, see what is required, and structure their physical therapy treatments accordingly," Edwards says.

Full-service treatment

For companies that want the service, HEALTHSOUTH will take on-site services one step further. The provider will set up a clinic on site to treat all injured workers, whether they were injured on the job or on the golf course.

Typically, the company provides the space, and HEALTHSOUTH brings in the equipment needed.

Some companies contract for physical therapy services only for their workers’ compensation patients. Others provide the service to all injured employees, on the grounds that on-site therapy saves employees time going to and from the clinic.

HEALTHSOUTH works closely with insurance carriers, physicians, and nurse case managers to determine which employees would be appropriate for the on-site services. Employees who are not ambulatory or who have not been released by their physician for light duty would be among those who are not appropriate, says Joan Buckler, PT, ATC, area manager for HEALTHSOUTH Corp., who is based in Charlotte, NC.

Typically, the companies contract for the on-site physical therapy services, although one insurer provides the service, Bucker says.

On-site services are not appropriate for all companies, Zehnbauer points out. It depends on the size of the company, the frequency of injuries, and whether employees are all at one site or in multiple locations, she says.

Flexible payment, treatment plans

For some companies, HEALTHSOUTH provides services just half a day per week only for workers’ compensation patients. At others, the physical therapist is on site five days a week and treats both workers’ comp and other patients.

"We are very driven by patient needs. We are very flexible with our accommodations and our pricing for them," Bucker says.

Companies negotiate on an individual basis for a payment plan. Some have an annual contract, others pay fee-for-service, Buckler says.

"We have a handful of ways we can bill for our services. Every time we go into a new situation, we work out an agreement that is comfortable for both parties," Zehnbauer says.

To provide consistency of care in staffing a clinic, one therapist has primary responsibility for a particular industrial account. If therapists work only part time at an industrial site, they will also work at an outpatient clinic or other facility the rest of the time.

Because the on-site rehab services are a new program for HEALTHSOUTH, the company hasn’t had a large enough volume of patients to separate outcome statistics from other statistics, Buckler says.