Utilization Management

Reduction in Physical Therapy Costs

CorVel’s experience in cost containment has shown that an effective way to manage physical therapy costs is through a combination of utilization management, timely communications and provider management. A comprehensive and proactively managed physical therapy program results in savings and improved return to work outcomes. The following highlights actual cases and real results from our program.

Medically necessary treatment
An injured worker was originally prescribed 24 physical therapy visits for treatment of injuries. Upon completion of CorVel’s utilization review, it was revealed that the patient also had comorbidities that were not benefiting from therapy and were ultimately delaying return to work. The CorVel Physical Therapist proposed discharge at 16 visits and limited treatment to the work related injury only.

Prescribed: 24 visits
Allowed: 16 visits
8 Reduced Visits Resulted in 33% Savings

Maximum medical improvement
An injured worker was prescribed 38 physical therapy visits with a clinical recommendation after 18 visits. It was determined by a CorVel Physical Therapist that the patient’s remaining deficits could be addressed with a home exercise program. Additional visits were not recommended and the patient was discharged at visit 18.

Prescribed: 38 visits
Allowed: 18 visits
20 Reduced Visits Resulted in 53% Savings

Unnecessary treatments
An employee with a strenuous work injury was prescribed over 50 visits of physical therapy during the course of care. At visit 18, CorVel’s Physical Therapist reviewed the patient’s progress report. The notes indicated the patient was working full-time, without any restrictions. It was determined that no further physical therapy visits were needed.

Prescribed: 50 visits
Allowed: 18 visits
32 Reduced Visits Resulted in 64% Savings