1. Conduct market research.

Page: When considering the implementation of a work-injury-management program, the first step that a therapist should take is to conduct market research to determine if this is a viable product line. This would consist of:

1. Surveying the competition to see who is currently providing this type of service and what their programs provide (treatment, FCE, impairment rating, job-demands analysis, etc) and their price points.
2. Surveying existing referral sources to determine if they currently refer for these types of services, and if so, what the volume might be.
3. Determining if new referral sources would be needed to achieve the numbers necessary for profitability and identifying who that would be (physicians, case managers, employers, etc).

2. Ask for copies of published research in peer-reviewed journals.

Page: Some homework is necessary when choosing the right tools for implementing a work-injury-management program. In today's environment—which is focused on evidence-based medicine—it is more important than ever to select tools with sound research backing. The implications of the decisions being made with tools such as FCE is enormous—the information can be used to determine someone's ability to return to work, whether or not they are a candidate for treatment, or assist in settling their case. To be able to trust the results, it is important to have a tool that has been studied for reliability and validity. When selecting the protocols to be used, ask to see the copies of research published in peer-reviewed journals.

3. Select tools that are practical.

Page: It is important to select tools that are practical, in terms of both cost and ease of use. Easy-to-read reports help the communication process—keep in mind that both medical and laypeople will be using the information generated. Objectivity in the decision-making is also important, as objective tools help prevent guesswork on the part of the therapist. Patient safety is also paramount—select protocols that are designed to minimize the chance for injury.

4. Differentiate yourself from your competition.

Page: When developing a marketing plan, it is important to differentiate yourself from the competition, and the best way to do this is with communication. A phone call to a referral source prior to conducting an FCE helps to clarify expectations—are recommendations desired, is there a job description, and if so, is a job match needed, etc—and this phone call may make a therapist different from their competition. Other ideas include same-day report turnaround and hand delivery, but forget the donuts—be different!

5. Recognize this is a specialty market.

Isernhagen: Therapists wishing to move into this field should realize that it will take them out of usual clinical thinking and out of their clinic. Just like sports medicine takes you to the athletic events, return-to-work programs may be partially done at the work site, or at the very least, a strong knowledge of the work site is necessary.

Return to work does have as a base excellent musculoskeletal treatment skills. However, the goals of treatment go beyond the traditional motion, strength, and reduction of pain. In order to meet the goals necessary in a return-to-work program, the therapist must know the work the patient will return to, how functionally competent the worker is now, and what the work goals that need to be achieved are.

6. Identify the transition back to work.

Isernhagen: It is also necessary to identify the transition back to work, perhaps even from the first day. While a treatment regimen will be used often, the return to work does not have to wait until treatment is complete. Willingness to describe modified work, ergonomic equipment, and functional tasks able to be done safely will be necessary for early and safe return to work. Goals are met when the worker is back at the original job full-time in 98% of the cases. For who will not achieve full functional recovery, the goal would be return to a new or modified job.

7. Expensive technology isn't necessary.

Isernhagen: It is far more important to have skills, an interest in analysis, the ability to interact with workers and employers, and the ability to match a worker to a job. This is all low tech, but it does require education and training and experience. I would start with training courses that teach you how to evaluate workers and do job analysis. Then, this will blend with treatment skills and goal setting. As an example, on-site therapists use very little equipment for treatment and functional testing, and they get the best results.

8. Simulate a work environment.

Isernhagen: If you are in a clinic, common equipment and the ability to simulate a work environment or work motions are very important. Rather than only "orthopedic equipment," the return-to-work specialist will use job-related tools, equipment, motions, etc. This will come from job descriptions/analyses mentioned earlier. Employers will often give you equipment and tools to use in the clinic so it doesn't have to be purchased. A worker or employer entering your clinic and seeing a Goodyear tire, a manhole cover, an office setup, etc, will be much more likely to work toward return-to-work goals as they see the value.

9. Market to previous clients.

Isernhagen: If the therapist has already worked in the community, workers from local industries most likely have been seen in his or her clinic. I would start by going back over your records to look at places of employment, type of work, etc. Getting back to an employer of a worker you have already successfully treated is a great start to building the relationships that return-to-work clinics need. Even if return to work wasn't accomplished on that previous worker/patient, the workers' compensation administrator from that company will appreciate knowing your future return-to-work intents and help.

10. Be willing to work with the employer.

Isernhagen: If this is a new clinic, then bringing new ideas and a willingness to work with the employer will help you gain the market. This will require visits to the industries with which you wish to work. If you are working with occupational medicine physicians, realize their customer is also the employer. You may be the liaison with your functional expertise. When job analysis is necessary for a patient, then this is the time to get to know the important people in the injury-prevention and management processes in the company. Education and ergonomic interventions are also additions to a return-to-work program and serve as an excellent introduction of you to any company wanting to know about your services.

11. Know what services employers are asking for.

Miller: When developing a return-to-work program, it is important to know what services employers are asking for and whether they want services delivered on-site versus in clinic. Identify the services your facility/staff can provide, noting areas where additional training is needed. Typical return-to-work services include functional capacity evaluations, fit-for-duty evaluations, job analysis, ergonomics, functional restoration, job-description development, and prework screen design. Successful programs focus on function beginning with the initial PT visit, utilizing objective testing to identify the injured worker's functional abilities compared to specific job requirements. Successful programs understand the importance of keeping injured workers active, productive, and on the job.

12. Identify equipment needs related to on-site versus in-clinic.

Miller: Be creative by utilizing actual job tasks whenever possible; simulate job tasks when needed. Establish hours of operation for both on-site delivery and in-clinic services. Determine whether on-site hours are needed daily, 2 days per week, or 3 days per week. Determine whether on-site hours need to cover multiple shifts. Develop an algorithm of care/expectations related to stay-at-work, transitional work, full-duty return to work. When working with a specific employer, understand the industry, the job requirements, and whether the employer can provide alternative duty options. Lastly, identify your program benchmarks, establish the billing process, and clarify whether a physician referral is needed.

13. Make sure training methodology is function-based.

Miller: When considering training for your therapists, make sure the methodology is objective and function-based, developed on evidence-based protocols, and research supported. Worker/patient safety should be incorporated. Training should teach therapists how to objectively evaluate/identify a worker's maximum safe ability levels compared to the job requirements to facilitate appropriate placement at work. The documentation system should clearly outline a worker's current functional abilities compared to the job goal, with functional status updates provided until full return to work is achieved. When choosing the right technology, consider how technologically advanced the equipment is. Compare cost with benefit. Is equipment easy to use? Does equipment hold up under use at the workplace? Are replacements available during maintenance? Is equipment portable? When choosing software options consider connectivity, reliability, cost of upgrades, annual licensing, per-user costs, storage, and access from multiple locations.

14. Marketing should be based on the program's success.

Miller: Your marketing message should focus on outcomes as a measure of your program's success. Track the number of treatments/visits from referral to return to work. Track the cost per case. Track lost time days compared to prior years. Highlight your program's focus on function, stay at work, transitional work, return to work. Use employer testimonials/success stories to illustrate how your program resulted in reduced workers' compensation expenses, decreased lost days, reduced cost per case, and/or improved worker morale.

15. Create the appropriate environment of care.

Seals and Johnson: Return-to-work programs can vary from large warehouses for work hardening to dedicated space as small as 10 feet x 10 feet for objective functional evaluations. For work hardening, the space needs to be approximately 500 square feet. Along with return-to-work programs services such as FCE's, post offer of employment tests and focused functional treatment can aide in returning an individual to work. The larger the space, the more job simulation can be employed. Within that environment, tools and equipment are the most important investment to consider when entering the return-to-work market.

16. Market with objectivity.

Seals and Johnson: Marketing your new service should start with the employer. In most states, the employer can directly influence where their employees go for treatment. Industry embraces objectivity. Partner with the employer to let them know that your goals are their goals. Providing them with objective measures of physical and work-task performance, including consistency of effort, asymmetry, functional weakness, and real-time heart rate, will demonstrate your level of commitment to providing the best possible environment for success. Once that relationship has been established, market to physicians and insurance companies using your employer testimonials to boost further referrals.

17. Invest in training and certification for your clinical staff.

Seals and Johnson: Most importantly, investing in proper training and certification of your clinical staff will help with staff recruitment and retention. You can build an aesthetically pleasing environment, equip it with the best equipment money can buy, but human capital can make or break the program. There are a number of outstanding and respected clinical experts out there who are providing continuing education to consider. By raising the standard of care in return to work programs, the physical medicine and rehabilitation community may just be able to make a dent in the $150 billion per year workers' compensation market.

Arati Murti is the editor of  Physical Therapy Products. For more information, contact .