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Multidisciplinary Work Rehabilitation Program  Following evidence-based guidelines, Northwestern Occupational Health (NOH) offers physician-directed, customized work rehabilitation programs for functional restoration. Individuals are transitioned back to work during the program whenever possible. Verne Backus, MD, MPH, who is Board Certified in Occupational and Environmental Medicine, supervises the program. Other interdisciplinary members are Lori Deering, PT, Larry Thompson, Psychologist, Rebecca Stucke, PA, and Kim Goss, RN, Case Coordinator. Dr. Verne Backus provides permanency ratings as needed. The program has been in existence for 9 years.
Programs are tailored to the individual needs of each client for optimum outcomes. The primary goal of the program is to provide quality treatment that leads to maximum medical improvement (MMI) by the end of the program. Additional program goals are for the client to:
- Achieve optimal physical activity and functioning;
- Self-manage pain to facilitate return-to-work;
- Leave the program with a defined work capacity;
- Reduce the misuse, overuse, or dependency on medications;
- Reduce/eliminate the use of ongoing health care services for primary pain complaints;
- Provide useful information to the patient and professionals involved in the case to help resolve any medical/legal issues and allow for case settlement.
Program Design:
Treatment programs are customized and established within the following two general categories which offer a comprehensive combination of physical rehabilitation, medical care, behavioral medicine and education:
- Work Conditioning, which typically runs 2-4 hours daily, 2-3 days per week for 4-6 weeks.
- Multi-Disciplinary Work Rehabilitation, which typically runs 4-5 hours daily, 5 days per week, for 4-6 weeks; may be extended based on individual need.
Medical services include a comprehensive initial consultation, weekly individual reassessment, weekly team evaluations, weekly gym rounds, and a final progress note indicating MMI status. A Narcotics Contract is utilized when indicated and may include clinical surveillance drug testing. Dr. Backus is on-site for program guidance.
Physical therapy provides a functional capacity evaluation, treatment in the areas of cardiovascular therapy, stretching and strengthening, work simulation, education, muscle endurance training, balance training, and flexibility. A discharge summary is provided at program conclusion.
Behavioral medicine provides a behavioral evaluation, individual pain management counseling, biofeedback, pain management relaxation training, and graded exposure to feared activities.
Client educational sessions are offered in such areas as functional goal setting, sleep hygiene, body mechanics, stress management, work task modification, pain control strategies, preventive medical strategies, etc.
Financial Investment:
The investment in a Work Conditioning Program ranges in price from $2,500 for a short, simple program to $7,000 for one with additional psychological and medical services; for a Multi-Disciplinary Work Rehabilitation Program it ranges from $8,000 to $13,000, depending on the type and length of services required.
Billing is by CPT code for all services, which allows for the most cost-effective, flexible approach to individualizing care. Prior authorization is required prior to program entry to assure that all parties agree on treatment to be provided.
- Physician assessment: 1 hour initial consultation at $348; weekly follow-ups at the VT fee schedule based on complexity.
- Psychological assessment and weekly follow-ups: $550-750; weekly follow-ups typically $136 each.
- Physical therapy work rehabilitation at the VT fee schedule: $208.43 for the initial 2 hours; $87.71 for each additional hour that same day.
- Functional Capacity Evaluation: $1275 - $1640 (or can utilize one from another clinic).
- Post-program: Dr. Backus permanency rating $348 (upon request).
A pricing estimate for a specific individual can be provided upon request.
Inclusion/Exclusion Guidelines:
NOH has established inclusion/exclusion guidelines so that clients are appropriately placed in our program. These guidelines will be discussed with the case manager/adjuster at the time of referral.
Case Coordination/Team Meetings:
Communication with clients and their case manager/adjuster is a top priority of our programs. Multi-disciplinary team meetings are held weekly to discuss client progress and treatment plans. Clinicians communicate frequently with case managers and adjusters, both by phone and by means of the documents listed below. Case managers and adjusters can also be scheduled to attend Team Meetings. Additionally, the Team does weekly rounds in the gym to communicate with clients, assess their progress and provide immediate input.
The following documentation is provided to the nurse case manager/adjuster:
- Initial Physician Consultation
- Functional Capacity Evaluation
- Behavioral Evaluation
- Weekly Team Meeting notes
- Discharge Summary
- Physician note at the end of follow-up
Other:
For participants who commute a long distance, the NOH case coordinator can facilitate making hotel arrangements. Lunches are provided free of charge when indicated.
Follow-up:
Follow-up recommendations are determined at the Discharge Team Conference.
For those clients who have successfully completed their Work Rehabilitation program, the Step-Up Program at NOH provides a means of continuing their independent exercise program in a familiar environment for a short-term with some PT guidance. Clients are able to come to the NOH gym at specified times and exercise independently. This also provides the insurance company with an option for continued case oversight at minimal expense ($25 weekly). The Discharge Team makes a recommendation at their final meeting regarding the number of weeks for this program.
Outcomes:
For 2005-2007, 94% of patients for whom NOH was following their medical care were placed at maximum medical improvement at the end of their work rehabilitation program. Additionally, 3 patients were discontinued due to oppositional behavior and non-compliance.
Northwestern Occupational Health provides coordinated care during all phases of treatment. With this integration of care, clinicians can closely follow patients to reduce delays in care. These services include nerve conduction studies, diagnostic imaging, laboratory services, and coordination with referral physicians and external testing.
For more information, please contact Kim Goss, RN, Case Coordinator or Christine Sweeny, Executive Director.
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