Clinical Oversight Reduces Claim Costs by Recommending Discharge Over Added PT

Problem

To control escalating therapy costs, a managed care organization implemented a system of regular reviews for additional physical therapy (PT) authorization requests. They sought a clinical partner with PT expertise to provide informed recommendations on whether to discharge patients or approve continued therapy.

Solution

Apricus provided clinical oversite for their additional PT request for cases like these:

• 24 additional PT visits were ordered for a patient with a post finger fracture who had already completed 21 PT visits. A clinical review was completed, and discharge was determined to be appropriate, avoiding 24 potential unnecessary visits.  

• A patient with an ankle sprain was authorized for 14 PT visits but only attended four. When additional PT was ordered, a clinical review was completed and determined discharge was appropriate and the patient was ready for return to work. Early discharge recommendations removed 10 unnecessary PT visits.

Outcome

In one month, the Apricus clinical team reviewed 23% of this client’s requests for additional PT approval. Working closely with both the treating provider and case manager to implement our recommendations we achieved 53% savings through reductions in the number of visits authorized compared to the number of visits ordered.