Early Physical Therapy for Lower Back Pain Reduces Costs to Medicare

Early Physical Therapy for Lower Back Pain Reduces Costs to Medicare

By Staff.

A new study on the cost of treatments for lower back pain showed that newly diagnosed patients with low back pain who received physical therapy as their first intervention had lower total Medicare costs and improved function compared to those who got injections or surgeries as their first intervention.

The independent analysis, conducted by health care research firm The Moran Company (TMC), assessed different initial interventions and associated costs for low back pain, within the Medicare program.

Those who received physical therapy first experienced a 19 percent reduction in Medicare fees compared to those who initially received injections; and approximately 75 percent less than those who received surgery first.  In addition, patients who opted for physical therapy within 15 days of being diagnosed, saw 27 percent lower average costs due to fewer required follow-on health care services such as injections and surgeries.

The also showed that in the year following the initial diagnosis, the people who had physical therapy first saved 18 percent more than those who received injections, and 54 percent more compared to patients who underwent surgeries.

“More than 80 percent of the U.S. adult population experiences low back pain,” said Troy Bage, Executive Director of APTQI.  “This research speaks loudly to the potentially significant cost savings and improved functional outcomes that early physical therapy can provide if implemented with the first 45 days after diagnosis.  Getting patients back into a productive daily routine at a lower cost is a win-win.”

The study was based on a comprehensive accounting of Medicare Parts A and B program spending for a population of patients based on the initial treatments received following low back pain diagnosis.  It used nationally representative Medicare claims datasets across multiple service sites, tabulations of total Medicare A/B spending on average for groups of patients with a low back pain diagnosis who received physical therapy or injections or surgeries first.

The study findings were announced by the Alliance for Physical Therapy Quality and Innovation (APTQI), which is an association that promotes physical therapy services.

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Authored by: Staff

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INCOME and recurring obligations for those that suffer chronic pain is a very important factor. IF I could retreat at least ONCE per year, it would still be a miserable, costly, and ineffective for MY personal health condition attempt at easing chronic pain . I have had most every “treatment” for chronic pain, A thru Z. I WISH options other than what has been effective for me, as an individual dealing daily with chronic pain was available in an effective treatment. I have earned “a living” for over 20 years with “due diligence” prescribing”, responsible use of medication, and determination on my, the patients part. Maybe I am a little more motivated as I have owned a business, a small one but, it has met my families needs for over 36 years. “Stretching” will not help with my condition as I am very active in my line of work. I understand that “targeting” a specific area can be beneficial to exercise but, not all chronic pain can be exercised to lower the pain level.The disabled chronic pain patient, on a fixed income can not afford alternative treatment therapy and most likely through the medication prescribing ideology previous to the CDC “guideline” have already been on alternate types of treatment to find that medication is the only treatment that really helps lower their pain level. So many variations of health conditions with so many opinions. Our physicians have been under the “rule” of prescribing with “due diligence” and the possibility of EXTREME penalties for over prescribing. The “guideline” is an absolute swing in prescribing to “fix” all abuse, misuse, and illicit drug problem use. However if a “guideline” is causing worsening pain levels and NOT curbing the mortality rate with illicit drug use, then abolish or at least amend it to ASSIST those with recorded chronic pain records and ZERO infractions.

[…] The Morgan Company (TMC) a health care research firm conducted a study on the cost of treatments for newly diagnosed patients with low back pain; the study found those individuals who received physical therapy as their first intervention had lower total Medicare costs and improved function compared to those who got injections or surgeries as their first intervention. Read article here… […]

Jean Price

A study based on “comprehensive accounting”… of Medicare and Medicaid patients with back pain!? So, what is the patient outcome in this study?! Money spent has little to do with correlating patient function, in my opinion! So unless the physical therapy regime was standardized and truly meant people had less pain and could therefore function better…well, this isn’t about health care…it’s bottom line cost management! And we see too much of this as it Is!

Physical therapy is much less effective if it’s what some therapists call “fake and bake”…which refers to assisted stretches and heat packs, even tens unit type sessions…without strengthening and endurance exercises. In other words, without hard work…to show measurable gains! That type of physical therapy actually can really help people with back pain and back problems and it’s usually an intensive six week work- hardening tyoe of program,,.which most insurances aren’t excited about covering! (And many seniors would have difficulty even participating in!)

Bottom line theology rarely is about establishing long term, result oriented heath care to improve function! It would be interesting to know if some of those people just never went back for further treatments of any kind. Wouldn’t that be cost effective for the insurance company too?

Linda Godowsky-Bilka

After my auto accident caused ruptured discs I was immediately sent to the hospital’s local physical therapy office in my town about an hour away. After registering I had my first session. I am on Medicare. When I checked out I was told to come 3 times a week for 6 weeks to start. Then the receptionist said “today’s visit will be $28”.
I asked do I pay that for every visit. Yes. Well, that’s $84 a week, $336 a month.

Being on Medicare and a fixed income, no way on earth could I afford anything remotely that expensive every week or month. Not too many folks I know could find that kind of extra money.

Insurance or no insurance - physical therapy is expensive.

The EDNC has suspected this for many years after reaching the same conclusions back in 2005 based on the available metadata of that time. Clearly this new report will help CMS determine better procedural protocols to treat patients with acute back pain. However, this may not be well received by the epidural steroid injection (ESI) industry, especially since this study sheds new light on the poor efficacy of ESI’s versus other interventional treatments. We believe that the Morgan Company along with ATPQI should be congratulated for their exceptional effort, but they now need to go one step further with their research.

Keep in mind that the ESI industry promotes their services to CMS as a cost saving treatment. They pitched the idea on the premise that their non-FDA approved therapy would significantly reduce the need for back & spinal surgeries. Unfortunately for them, this claim is not supported by the current medical literature. In 2013 we proposed to CMS management that a review of their post ESI expenditure reimbursement record would most likely show a huge spike in payments due to unreported injuries following ESI treatments nationwide. So rather than reduce the need for surgery, we suspected (based on the same metadata and our own observations) that ESI therapies could be doing the exact opposite due to a wide myriad of known severe medical event outcomes following spinal steroid injection procedures.

Therefore we challenge the Morgan Company to expand their study to determine whether or not our suspicions that ESI therapies are neither cost saving nor efficacious, are valid by examining post ESI expenditures nationwide by the Center for Medicaid & Medicare Services.

Michael G Langley, MD

If they worried about long term results, they would pay up front for interdisciplinary (the real type!) therapy and save bundles! Thing is, they worry too much about the bottom line and not the patients’ quality of life!

Sandy M

I went thru PT so many times, my neurologist told me I was only increasing the pain in my lower back. After MRI”s I went thru a series of injections at 3 pain clinics, each telling me their’s would be even better. The injections and procedures they put me thru never helped at all. Finally I went to a spinal surgeon at a University Hospital with my records of all the PT, injections and procedures i had gone thru for about 5 years and he had approx. 40 x-rays taken. After they hung about 20 up, my husband and I couldn’t believe what we saw. My entire back looked like a huge letter “C” I had Scoliosis that had progressed so fast which now made so much more sense why I was bedridden. Prior to all these back problems, I had a right hemorrhage stroke in the thalamus, which had left me with a pain condition called Thalamic Pain Syndrome for which there is no cure and after trying a truckload of pain medications, I didn’t want an opioid, but after years of trying to find a pain medication, I couldn’t take anymore and was so depressed, I finally gave in to a very low mg. dose of pain medication that gave me enough relief to feel like getting up and having my kids and grandkids come over. It helped so much. I didn’t take a pill until my pain was so bad, I could put a cold pack on my back for 20 minutes and after about an hour, my pain was better, but it was only a break thru mefixation and didn’t last long. But ohhhh. It was worth some relief. I then had tests scheduled for the Scoliosis surgery, when they found I had a 90% blockage in my right coronary artery. I had Stent surgery for that and a few months later had the Scoliosis surgery from my T3 to mY LS-51. My entire back is metal. That was 4 years ago and I still have low back pain, and can’t walk very far without a cane, the Scoliosis pain is better, because without the surgery I would be in a wheelchair. I am still unable to do a lot of things, but this is because of that horrific, burning, constant 24/7 stabbing pain from the stroke. Without my husband’s help, I would not be able to put on socks, shoes and many other things I need help with. But all these rules and regulations the government agencies are putting on us, we have already been thru these things before ever being prescribed pain medication. We shouldn’t be included in the junkie, drug abuse system. Those people will continue to find drugs for their “high.” We just want some relief from pain. I just don’t understanD why they treat those of us in such pain like they are doing. Our doctors have known us for years. Diabetics have to take insulin for their health. My doctor… Read more »


In my case intensive pt early DID NOT HELP.

Nothing is a panacea. No one thing works for all. Unfortunately.

All the algorithms in the world will not apply to everyone or even most. Sorry.

please stop lumping everyone together,.

In total agreement that early physical therapy is lower medicare cost, but it will also lower pain intensity and frequency. If your insurance covers adequate physical therapy visits. However, there are things that “we” as patients can do We can eliminate pro-inflammatory foods from our diet, start getting active and have a supportive social network that understand what “we” all go through. Last year we did this at a patient retreat in LA..Patients and their caregivers got to experience this first hand. We did sunrise walks, had an Autoimmune diet for the entire weekend and created a national support network that continues to grow!! Patients couldn’t believe they could sleep through the night, enjoy their meals and actually have fun!!


New studies with real results, could be encouraging. Facts, studies, and figures, are all important factors in decision making from the “qualified”, elected, and appointed in health care making “policies” but, the “quest” for pain relief for the millions that have been sufficiently treated for, previously, the new “social reform consciousness ” agenda is causing treatable, continuous, pain generating health conditions to worsen, by the day. The IMMEDIATE “epidemic” seems to be the lack of, sufficient medication. There is no ONE study, treatment, medication, or reduction of medication leading to the chronic pain patients health condition to be rendered a success. For millions of people whether their chronic pain condition can be sufficiently treated to achieve a better life, life with less intrusive pain, may not be a possibility for even the near future. The CDC “guideline” and accompanying misery thrust upon existing, stably treated, patient with no “infractions” previously to the mis-guide-line ARE suffering without regard from the health care “advisory” policy makers… INCREASED pain, is evident as stated by our physicians, pedigreed health care specialists, a variety of different medical associations and lastly, the chronic pain patients’ voices. The patients’ needs, effective treatment, is being ignored. Studies, a different effective approach to preventing chronic pain, a comprehensive policy, treatment….. for the many different issues relating to chronic pain management needs must be adopted but, incorporated into pain management measures on a realistic, effective for the patients INDIVIDUAL health condition, in the future. The”cattle” approach to “one and all” treatment for the EXISTING chronic pain patient, with years or decades of effective treatment has been profusely VIOLATED of recent. An ineffective “guideline” for the disbursement of medication, in sufficient dosage, for the established, chronic pain patient with the “hope” that death by overdose of opioid medication, one and all, is irrational. ONE doctrine, policy or guideline. NOT gonna happen. The determent of the mortality rate by ALL that either use, misuse, or abuse, medication AND illicit drugs is the stated “target” populous for a “guideline”. Supposedly based on specific, well studied information has this policy been enforced on “one and all” people with ANY history of “drug abuse” but, also upon chronic pain health, very treatable, health condition patients.. Chronic pain caused by a particular health condition, young and old, with a conservative or liberal mindset, employed or unemployed, religious or non religious, male or female, inside the “city” or outside will CONTINUE to be a part of reality. It is NOT realistic to enforce any ONE doctrine, policy, or guideline and truly achieve positive results with any ONE health condition or situation. The CDC “guideline” was the easiest, fastest, and most irresponsible approach to slow or even curb ALL negative continuous pain generating health conditions whether willfully incurred or medically placed upon an individual for perceived “drug abuse” by “one and all” people of this country. This is not a negative response to encouraging studies for future pain management patients and “drug abuse” or perceived abuse because, it… Read more »