Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape

Abstract

Purpose: With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). Methods: A review of payment models, workers’ compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Results: Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Conclusions: Robust evidence of the benefits and costs associated with different payment models – from the perspectives of clients/consumers, funders and service providers – is needed to inform best practice in rehabilitation of compensable workplace injuries.

Implications for Rehabilitation

• Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers’ compensation settings, although there is little evidence of service quality or client satisfaction.

• Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers’ compensation settings by allowing more clinical autonomy and innovative practice.

• Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

• Fee-for-service
• performance-based
• post-acute care
• stress
• traumatic injury
• vocational rehabilitation
• workers’ compensation

Declaration of interest

The first three authors report no conflicts of interest. Author C. H. has worked in the workers’ compensation industry for the past four years. In previous employment with a large national insurer, C. H. was responsible for changing a compensable injury payment model from a fee-for-service system to a mixed payment system where some services were billed using performance-based methods and other services billed using the fee-for-service, depending on the severity of the compensable injury.