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  • Referral to Physical Therapy Lowers Care Utilization for LBP vs Referral for Imaging

    A recently published study of patients with new low back pain (LBP) who received referral from a primary care provider concludes that not only is physical therapy a less expensive next step than advanced imaging, it's an approach that results in lower utilization costs over time.

    Researchers Julie M. Fritz, PT, PhD, FAPTA, Gerard P. Brennan, PT, PhD, and Stephen J. Hunter, PT, PhD, OCS, analyzed utilization records and other health information for 841 individuals who consulted with a primary provider about uncomplicated LBP and were referred for management outside primary care within 6 weeks. Of those individuals, 385 received advanced imagining and 377 received physical therapy (the remaining 79 patients received a physician specialist visit or "other care," including chiropractic). The study focused on records obtained from 21 different providers around Salt Lake City, Utah, between 2004 and 2010.

    What they found was that across the board, physical therapy was the less costly approach. Initial referral for physical therapy cost $504 on average (for an average 3.8 visits), compared with an average of $1,306 for magnetic resonance imaging (the technology used in "almost all" of the imaging, according to authors).

    Even more dramatically, average subsequent costs over the next year were over 66% lower for the patients who began with a physical therapy referral--$1,871, compared with $6,664 charged to the imaging group over the same time period. Those differences remained largely in place even when researchers matched individuals for covariates including prior surgery, use of medication, osteoporosis, and mental health issues. Results of the study appear in the journal Health Services Research (abstract only available for free).

    Authors found that patients who receive imaging as a first referral often follow a different path than those who receive physical therapy, writing that referral to imaging "increased the odds of surgery, injections, specialist, and emergency department visits within a year."

    Researchers attribute some of the variation to perceptions around imaging. "Advanced imaging often 'labels' a patient's LBP that might otherwise be viewed as nonspecific and uncomplicated, causing heightened concern in some patients and providers and motivating additional care-seeking," they write.

    On the other hand, they write, "physical therapy may avoid the negative consequences of a labeling effect from imaging" by "provid[ing] patients with an active approach to LBP, enhancing patients' perceived ability to self-manage their condition."

    "This is important research, because it provides even more evidence that physical therapy is a less costly alternative to medication, surgery, and other invasive medical procedures," said Nancy White, PT, DPT, APTA executive vice president of professional affairs. "Not only do patients benefit from the improved outcomes resulting from an active approach to care, society benefits from the reduced financial burden on our health care system. The cost savings Fritz and her colleagues describe here are significant enough to be recognized by health policy makers, payers, and other health professionals."

    Authors acknowledge that their study was limited to newly reported and uncomplicated LBP, and that patient-centered function or satisfaction outcomes were not recorded. Still, they write, for individuals with this type of LBP who have expectations for additional care beyond a primary provider, "physical therapy may be the preferred initial step instead of advanced imaging."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • Can this article be sent to a news station i.e. Fox or Good Morning America.....

      Posted by claire jacobsohn on 3/18/2015 6:36 PM

    • Ron Donalson's book ""Rapidly Reversible Low Back Pain" An Evidence-Based Pathway to Widespread Recoveries and Savings came up with the same conclusion with copyright in 2007. So, now what does all this mean? How can we spread the work to those who prescribe Physical Therapy for acute LBP? We are the best resource for treating acute and chronic LBP and we should see patients pre-surgically as well just incase these people centralize with directional exercises!!!

      Posted by Gerald Pica on 3/18/2015 11:52 PM

    • When will DPT's practice at the top of licensure and BE the primary care for MSD's including LBP? Or in other words-when will practice start to reflect the evidence?

      Posted by Tim Thorsen on 3/19/2015 9:48 AM

    • We have noticed this for years, and it is worse with auto injuries, but across the board, PT is the cost saving route and more research will support this. We have not proved this in acute care, that PTs are cost savers, but in out patient care it is the same... so why is Medicare capping PT at just over the cost of a few tests?

      Posted by william scott barnett on 3/19/2015 10:41 AM

    • I AGREE WITH THE IDEA FOR CONTACTING the MEDIA!!!! This finally begins to show what conservative, holistic care care can save our entire country, and legislators/the public desperately need this kind of information due to high deductibles and other costs in healthcare, before the medicare caps and SGR take affect permanently!!!!!!

      Posted by Kate Humphrey on 3/20/2015 10:03 AM

    • This information should be sent to payers as well. Most of the decision makers in the insurance industry are not from medical field and studies like these helps them understand our value.

      Posted by Liza Tan on 3/22/2015 11:49 AM

    • So you are wondering the "value" of a PT. Well, a little math would suggest (at the present inefficient utilization) if seeing a PT 3.8 visits ends up costing a total of $1,871 (and this is obviously for more than just the PT visits), compared with $6,664 charged to the imaging group over the same time period that means that a PT could see (at 10 visits/day) could see 500 "cases"/year. 500 x a savings of $4793 per case comes out to $2,397,550 per PT per year. Using the "old" savings from the previous study by Fritz and Brennan on "compliant vs. non-compliant physical therapy) I was worth somewhere between $600,000 and $1,000,000/year. So, my value continues to appreciate as more detailed analysis is completed. It is crazy we even have to debate this issue when the savings are so huge. I could get it if we were 10% less but millions less! Why or why can't we get this point across.

      Posted by Herbert Silver -> >JX^D on 3/22/2015 2:41 PM

    • I've practiced for 43 years now. When I started we, PT's and physicians "diagnosed" spine pain by symptoms, history, movement and our hands. This was refined by Kaltenbourn, Maitland, Paris, Grieve, McKenzie, Mulligan, Cyrix and Stoddard, to name a few. We didn't have the MRI industry. We obtained success and this study demonstrates this point. Learn your craft. Use your head and your hands. There is a place for MRI, for our failures and definitely before deciding on surgical correction. How many times do we see an MRI that while showing pathology has nothing to do with the case. How many times do we suspect age related changes that can be handled by physical means, exercise and ergonomic changes, that went to MRI, and then to epidural block. With cost constraints we are the choice for conservative treatment and have been proving this for my 43 years in practice. We should be proud of this study.

      Posted by Arthur Mattmiller PT on 3/22/2015 6:31 PM

    • That is really an interesting study! I had no idea that therapy cost that much! I am lucky that my insurance covers most of mine so while it is money I'm spending, it is cheaper than most.

      Posted by Drew Harrison on 7/1/2015 8:33 AM

    • It's interesting to hear that physical therapy was less expensive than the magnetic resonance imaging. So far a lot of our technology has yet to compete with many traditional methods, in terms of their ubiquitous nature, or lack thereof. Physical therapy is more financial available to each person.

      Posted by Steven Harrison on 10/6/2015 9:49 AM

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