Mark Pew, senior vice president at Prium, a workers’ compensation medical interventions provider, is arguing for the need for more holistic treatment for injured workers.
“What happens between the ears and at home has as much to do with the ability and willingness to get better as what is physically wrong,” Pew wrote in a report recently published by WorkCompWire. “A biopsychosocial model is common sense. It acknowledges
that a patient – in the case of workers’ compensation, an injured worker – is built of more than just skin and bones and muscles. And the entire fiber of that person – everything that makes them a human being – has to be actively engaged in a recovery process for it to produce positive clinical outcomes.”
Pew also examined the workers’ compensation sector’s attitude toward behavioral treatment modalities, particularly how far payers and providers are willing to support such treatments with actual insurance dollars. He explained that health and behavior CPT codes
commonly used in workers’ compensation classify them as treatment methods rather than diagnostic tools. Quoting Mississippi psychologist Geralyn Datz, he said that “frequently, the only way to treat a workers’ comp patient with cognitive behavioral therapy is if the patient has co-occurring pain and if the provider is willing to be underpaid.”
He also noted that gym memberships, yoga, smoking cessation, weight loss and proper nutrition are often snubbed in treatment
programs because they do not formally comprise medical interventions.
“Because ‘psych’ and ‘social’ are pertinent to treatment and recovery by definition, they are ‘compensable’ to work comp, either by direct payment or increased duration of disability and delayed return to work,” Pew explained. “They have a tremendous impact on whether that person gets better. And facilitating [getting] ‘better’ is the goal of workers’ compensation.
“Are we being penny wise and pound foolish by paying for the wrong things and not paying enough for the right things?” he continued. “There are many in workers’ comp who believe in the biopsychosocial model and are proving it with their dollars. But there are just as many, if not more, who have yet to adjust their mode of thinking.”
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