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Cost Effectiveness of Physical Therapy With or WIthout Primary Care

Health care costs have continued to outpace inflation each year.  Our previous posts have detailed the cost savings associated with seeing a Physical Therapist for many musculoskeletal conditions.  In addition to saving health care expenses, Physical Therapy produces excellent outcomes for many musculoskeletal conditions.  A recent review article summarized the cost effectiveness of Physical Therapy alone or with usual care for various health conditions.

Burge and colleagues reviewed the available literature from 1998-2014 and included 18 research articles in their review (Physical Therapy 2016).  The authors found Physical Therapy alone or added to usual care improved health outcomes in the vast majority of studies.  In addition, Physical Therapy alone or in combination with usual care was cost effective for many health conditions.  Patient are encouraged to pursue Physical Therapy interventions for their musculoskeletal complaints to improve outcomes and reduce health care costs.  

Cost Effectiveness of Physical Therapy for Low Back Pain

Low back pain continues to affect many Americans leading to pain, loss of function, missed work days, and higher health care expenditures.  Much of this cost is attributed to the often unnecessary utilization of advanced imaging and procedures such as injections and surgery.  Previous research has shown early access to Physical Therapy without a prior MD referral saves patients on average $1000 per episode of care.  Further cost savings are noted if patients are treated early with Physical Therapy compared to national guidelines advocating a "wait and see" approach for care prior to deciding on Physical Therapy.  

A recent study was conducted to determine the cost effectiveness of primary care management with or without the use of early Physical Therapy for patients with acute low back pain (Fritz et al. Physical Therapy. 2016).  Economic data was collected on 220 patients with acute low back pain who were all treated with primary care management (education, medication) and then randomized to either 4 sessions of early Physical Therapy or primary care management alone.  The authors collected costs (health care treatments, loss time at work) associated with this episode of back pain.  The authors concluded that Physical Therapy was associated with higher quality of life scores at 1 year and was sufficiently cost effective to support its' early use for patients with acute low back pain.

Patients with low back pain are encouraged to seek out the services of a local Physical Therapist to reduce health care costs and improve symptoms and function compared to primary care management alone.  

PT Visits in Physician Owned Practices Comes at a Cost

Patients have a choice for where they attend Physical Therapy even if directed to a single PT practice by their physician. Unfortunately, physician owned physical therapy practices, either on or off site, are on the rise around the country and referrals are being driven to these practices due to financial incentives. These practices often utilize less qualified personnel (aides, technicians) to deliver PT services at a higher cost than independently owned practices. In addition, research shows these practices utilize a higher percentage of passive modalities (ultrasound) inconsistent with current medical research guidelines.

A recent article highlights the importance of choice when patients select a Physical Therapist after knee surgery.  Mitchell and colleagues researched Medicare data on 3,771 total knee replacements performed between 2007 and 2009 (Health Services Research. 2016).  Researchers divided these patients into three groups based on where they attended Physical Therapy and the financial relationship between the Physical Therapy clinic and the physician.  

1. 709 patients received PT a a clinic where there was a financial connection with the physician  

2. 2215 patients received PT at a clinic where there was no financial relationship             

3. 847 patients received PT at a clinic with an independent provider, but referring physician had a financial interest

The researchers found patients who received Physical Therapy at a physician owned clinic were seen for twice as many visits and received less individualized care.  Authors also noted a decrease in intensity at the physician owned clinics likely responsible for the longer plan of care.  Intensity was described as the amount of individualized interventions designed to improve range of motion, strength, and endurance.  These results are consistent with prior research demonstrating the key financial and quality differences between physician owned and non physician owned Physical Therapy practices.   

Patients are advised to research into the ownership of their Physical Therapy clinic and choose a Physical Therapist who can deliver the most effective and efficient interventions possible.   


Timing of Physical Therapy and Patient Outcomes

Currently in the United States the majority of citizens can access their Physical Therapist without a prescription from their physician.  As shown in the map above, arbitrary restrictions on this access has been put in place through state legislatures with strong influences from special interest groups.  In Colorado, patients can access their Physical Therapist without restriction allowing them to enjoy the improved outcomes and decreased cost associated with this healthcare pathway.  On average these patients will save $1000 per episode of care and avoid the unnecessary and high risk pathway including medications, procedures, and surgery.  In addition to these benefits, research is now highlighting how this pathway can improve outcomes for patients with musculoskeletal problems.    

The majority of the musculoskeletal aches and pains are best treated early allowing the Physical Therapist to maximize outcomes in fewer visits.  A recent review article in the Journal of Sports and Orthopedic Physical Therapy highlights the importance of early vs. late access to Physical Therapy services (Ojha et al. 2016).  The authors reviewed 14 research articles to examine the impact of early Physical Therapy on health care outcomes.  Consistent with prior business and research articles, early Physical Therapy was associated with decreased costs and future health care utilization.  Patients who receive early Physical Therapy are likely to require fewer physician visits and avoid unnecessary and costly interventions including surgery.  

Patients are encouraged to round out their health care team of a physician and dentist by adding a Physical Therapist.  Seek out a local, knowledgeable Physical Therapist (early) for advice, questions, and treatment of your next ache or pain.