Study: Adherence to Physical Therapy Program for Low Back Pain Can Reduce Overall Medicare Spend

Study: Adherence to Physical Therapy Program for Low Back Pain Can Reduce Overall Medicare Spend

By Staff.

A study by the Alliance for Physical Therapy Quality and Innovation (APTQI) shows that people suffering from lower back pain who adhere to a standard physical therapy regimen with multiple visits cost less in overall Medicare expenditures than do patients with fewer outpatient therapy sessions.

“These latest findings suggest that the intensity of physical therapy in terms of the number of visits, is inversely related to total Medicare spending,” said Erik Williams, Executive Director of APTQI.  “This study is one more indicator that sticking with a physical therapy program can help patients ease the pain in their lower backs as well as their wallets. Those in charge of insurance design should be looking at ways to remove barriers to physical therapy and improve attendance, not the other way around.”

The independent analysis, conducted by health care research firm The Moran Company (TMC), assessed 38,260 Medicare patients.  All patients had a lower back pain diagnosis and an outpatient physical therapy visit in the year following that diagnosis.

Approximately 22 percent of those patients had a single therapy visit. The remaining patients averaged 9.1 therapy visits over the course of eight weeks. Patients with multiple visits incurred 14 – 32 percent lower average total Medicare spending in the year following their diagnosis than patients with one therapy visit in the same timeframe.

The study also found that 94 percent of the patients who had more than one therapy visit spent an average of $625 for outpatient therapy services. That fee is lower than the typical cost of an MRI or other diagnostics that don’t resolve the condition.

TOTAL MEDICAL SPEND BASED ON PHYSICAL THERAPY VISITS

VISITS COST
1 $14,954
2-4 $12,912
5-8 $10,361
9-12 $10.221
13+ $12,013

You can view both an Executive Brief and the Full Study by clicking on the following links to PDF files:

Executive Brief: https://www.aptqi.com/Resources/documents/APTQI-Summary-Physical-Therapy-Episodes-Lumbago-October-2017.pdf

Full Study: https://www.aptqi.com/Resources/documents/APTQI-Complete-Study-Physical-Therapy-Episodes-Lumbago-October-2017.pdf

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Authored by: Staff

There are 12 comments for this article
  1. Carmen M at 11:40 pm

    Well that all depends on where the insurance provider is obtaining their “magical” number of visits from that is dictating this “one-size fits all approach” that sounds all to familiar from another well known government agency. When I was prescribed PT, my Medicare Advantage Plan was allotting a patient 6-8 visits a year per diagnosis at $30 a pop. So I guess in their eyes, after 8 visits, and no matter what condition I’m in, I’m suppose to be magically “cured.” And Medicare is saving money how?

  2. Paul at 9:14 am

    Interesting study when you look into the details, not by what is shown, but by the glaring omissions in the study.

    1) The study was sponsored by Physical Therapists – a direct financial conflict of interest. If we are going to dismiss studies by Pharmaceutical Firms showing opioids reduce pain than this study also must be omitted.

    2) There is no data to standardize the condition of the patients. Thus someone that only completed 1 session may have had more significant problems than those completing 50 weeks (the maximum tracked weeks).

    3) The authors FAILED to point out another interesting point of the study: After 12 weeks, the costs of physical therapy start to exceed the savings. Why is there this change at 12 weeks?

    4) The authors did not take into account the reason that people did not continue with therapy so factors such as increased pain due to PT could not be eliminated as a cause for the high dropout rates.

    5) Finally and most importantly, the study groups all “lumbago diagnosis” into a large bucket. Lower back pain has multiple causes so why not get more granular to determine which TYPES of lower back pain do well with physical therapy vs those that do not. The high drop out rates could be related to specific diagnosis, but the data was not exposed.

    Thus we have a great marketing campaign by physical therapists on why we need more physical therapy!

  3. Linda at 6:32 am

    Useless information. I get tired of reading all these far fetched ideas (bogus studies) from every Tom Dick and Harry that puts something out there.

    People in pain inherently know when they’re reading and wasting their time.

  4. MichaelL at 9:03 am

    The cost has always been the thing. As a private practitioner, I had a very difficult time getting anyone to participate in physical therapy modalities. They were just not covered. Biofeedback, acupuncture, TENS units, etc. were all limited. The opiates, that worked for many of my patients, are now demonized by a group of physicians, who seem to know little about the actual incidence of addiction amongst pain patients. It has little to do with the true nature of the “opiod epidemic” with which we are now being barraged. Then again, inserting spinal cord stimulators pays for a lot of the improved incomes of anesthesiologists! It makes the manufacturers, of the electronic units, a lot richer, too! The question is, why do they see a 33% success rate as a good result! I think they might be used in a beneficial manner. But, the failures should have another way to be treated instead of stating they failed and sending them to the curb. When are the doctors going to start trying to relieve the suffering in any way they can?! Their failures mean that patients are suffering, especially with the bogus “opiod epidemic” inserted in the mix!

  5. CathyM at 8:32 am

    I just had to drop my PT because even the co-pays were unaffordable for weekly therapy. However I did see a strengthening in my legs after 3 months (2 artificial hips had made my gait uneven). No reduction in pain, though, and no effect on my back pain… so I wonder at this study (which seems to have been commissioned by those who’d like PT to be “more effective” – WHY can’t we have objective studies????)

    I totally disagree with the comparison of diagnostic with PT costs!! If you don’t know what’s wrong, how much more likely is it that PT could make it worse? Compare PT to drugs or chiro or surgery, maybe, but not to diagnostic. I’m convinced the corporate medicine field does NOT want us to see what’s giving us pain, because they then couldn’t say it’s all in our minds. (My back xray shocked my doc out of his smugness).

  6. Kathy C at 8:02 am

    I wonder how many people who follow this site this applies to. I also wonder why with so many issues facing people with Chronic Pain, this “Study” done by Physical Therapists in order to promote their Industry and deceive the general public, this should get re posted here. Once again they conflate the issue of long term chronic pain, with people with occasional back pain, or “Low Back Pain.” Very likely people with “Low back Pain” with no underlying issues will respond to any kind of movement or exercise program, and even a change in a sedentary routine.
    There is nothing new or groundbreaking here. There is no Data on how many people with “Low Back Pain” are misdiagnosed, and have their condition worsened by Physical Therapy. This “Study’ was done to avoid capturing any Facts, and over generalizes “Low Back Pain.” Designed to deceive and promote their industry, like many of the other “Studies.”

  7. Wanita1 at 7:43 am

    When I attended Physio, the exercises were the same no matter how many times a week I went yet the cost was about $80 visit. To keep costs lower for Pts & insurance providers we need a system in place to help ensure compliance to program at home.

    Many exercises can be done using a tension band. Perhaps online buddy system would help keep Pts compliant.

    Even traction can be done at home to relieve pressure & pain in joints.

    Take home, on loan EMS devices might be helpful as well.

    If we brain storm & insurance stopped fighting people & instead focused on making Pts well I bet we could keep costs down while delivering quality care.

  8. Steve Macey at 7:30 am

    I agree with Denise. I didn’t state it… But that’s why I do my own aquatic therapy. I was allowed 18 therapy visits a year… 18 total weather if for PT or OT. With forever needing surgeries from a very bad car wreck. I can only do 1 surgery a year… Then my 18 PT/OT visits and then sit in pain till 365 days later I can start the next surgery! Right now I am still backlogged 6 surgeries. And dependent on MRI’s this week… Anywere from 0 to 2 more surgeries to add to the list. At this rate (if no more injuries) I should be out of chronic pain some time in the years 2024-2026.

  9. Kathy C at 7:27 am

    These kinds of Studies are designed to be deceptive. This might be factual, but the use of the words “Low Back Pain” can be interchangeable, and misleading. We know they probably picked people with typical Low Back Pain, Not people with underlying issues, or post Surgical “Low Back Pain.” The quality of Physical Therapists is also a factor, which their Industry has not addressed. Patients with underlying undiagnosed or misdiagnosed conditions, would in many cases stop going to PT, especially when it did not appear to improve their conditions. The ICD 10 Data they pulled these numbers from did not capture that information by design. The findings may be factually accurate, but the context is deceiving. The term Low Back Pain can mean anything from a minor discomfort to post surgical complications from Failed Back Surgery, or misdiagnosed cancer. The average Physical Therapist does not make any distinction, nor do the ICD -10 Codes. The ICD 10 Codes were designed to not capture any data about the incidence of misdiagnosis or mistakes.

  10. Denise Bault at 5:39 am

    PT may help, but who can afford it??? Those on a fixed budget will make a decision after one or two treatments as to whether they think it helps. Then they decide whether it’s actually “worth it” to continue. Sad, but true. Even if it does help, insurance puts a limit on the number of visits…so who’s the winner here? NOT the patient.

  11. Steve Macey at 3:43 am

    I agree with this finding. However my chronic back pain. And fibromyalgia. I found I suffered more flakes of fibro pain trying to keep to the PT program.

    We switched it to an aquatic program that greatly reduced lower back pain and subsequent fibro flairs and pain. Hence less pain meds. I learned all the maneuvers we were doing as well as making the equipment they used (pool noodles, PVC pipe and plastic cutting boards!) and continue to use friends pools and local YMCA pools (during winter) to keep my back a little stronger and less meds. Have met others at the YMCA and showed them and made friends to due are aquatic routines together.

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