• News New Blog Banner

  • Study Says Cost Savings of Physical Therapy for LBP Are Significant

    When it comes to physical therapy for treatment of low back pain (LBP), Medicare is getting a bargain, according to authors of a new study. Researchers say that not only is physical therapy cheaper than injections or surgery in the short-term, it's an approach that is likely to save on treatment costs for at least a year after initial diagnosis, with average savings of 18% over treatments that begin with injections and 50% over treatments that begin with surgery.

    The study, commissioned by the Alliance for Physical Therapy Quality and Innovation (APTQI), focused on Medicare A and B claims data from 472,000 beneficiaries who received a diagnosis of LBP and began treatment between February and October of 2014. Researchers from the Moran Company tracked 3 treatment paths—physical therapy, injections, and surgery—and compared total costs of initial treatment as well as total costs for 12 months after diagnosis. The study also included an analysis of cost differences associated with how soon physical therapy was initiated after diagnosis, the physical therapist interventions used, and relationships between the use of physical therapy and the referring health care provider.

    "We felt it was important to look at claims data to demonstrate how a physical therapy-first approach can improve outcomes and reduce overall medical expenditures," said APTQI Executive Director Troy Bage, PT, DPT. "We've known this to be true from our experiences as physical therapists, but we wanted to investigate the hard data that bear this out."

    Here's what they found:

    From an intervention cost perspective, physical therapy wins out.
    As an initial intervention, the average total medical cost when physical therapy was used first was $3,992—19% lower than total average costs when injections were used first ($4,905) and 75% lower than the total average costs for the surgery-first group ($16,195).

    Physical therapy also is associated with savings over time.
    Researchers found that during the 12-month period after initial diagnosis, individuals who received physical therapy as an initial intervention tended to rack up fewer additional costs than the injection and surgery groups. Average 12-month spending for the physical therapy group was $11,151, compared with $13,606 for the injection group and $36,772 for the surgery group. That's an 18% and 54% savings, respectively.

    Starting physical therapy sooner correlates with lower costs.
    Beneficiaries who received physical therapy within the first 15 days of diagnosis incurred lower average treatment costs than those whose physical therapy began later, and those savings continued through the 12-month study period.

    Active physical therapist services were the most common type of services delivered.
    Active physical therapist services accounted for 82.1% of the services delivered to the physical therapy group, with 5.7% recorded as passive and the remaining 11.2% designated as other interventions.

    Primary care physicians account for the most LBP diagnoses, but orthopedic physicians are most likely to refer patients for physical therapy.
    Overall, 37% of the LBP diagnoses in the study group were made by primary care physicians, with the next highest referrer being "all other" (32%). While orthopedic physicians accounted for only 8% of the diagnoses, they referred the largest portion of their patients—about 21%—to physical therapy. Primary care physicians referred 13% of their patients to physical therapy, while pain management physicians preferred injection referrals, sending about 36% of their patients to that treatment path.

    Most patients receive no physical therapy, injections, or surgery.
    Of the 472,000 cases studied, almost 13% received physical therapy, with 11.3% receiving injections and 1.6% receiving surgery. The remaining 74.4% of patients didn't receive any of the studied treatments during the yearlong study window.

    As for the makeup of the groups studied, the group receiving physical therapy tended to be slightly older, with an average age of 68.1 compared with averages ranging from 64.1 to 66.7 for the other groups (including those who received none of the 3 services). Beneficiaries who received physical therapy were also more often women (65.5%, compared with 50.5%-61.9%) and were not as often designated as disabled, with a 29.6% rate compared with 37.9% in the injection group and 44.3% in the surgery group.

    "The results of the study highlight the importance of initiating physical therapy prior to other more expensive and invasive interventions," Bage said. "The savings identified in the study are not insignificant and clearly correlate with better outcomes."

    Authors of the study assert that the timing is right for the study, and they say the results are promising.

    "In a Medicare policy environment focused on value-based payment reform and care management strategies aimed in part at cost reduction, understanding potential cost implications of first line treatment utilization is relevant," authors write. "The findings from this report signal possible advantages of [physical] therapy as a potential cost saver relative to other treatment interventions for low back pain. These results lend promising support for the role of [physical] therapy early in the care continuum from a cost perspective."

    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.

    Proposed Home Health Rule Includes $80 Million Reduction in 2018, Potential $950 Million Reduction and Move to 30-Day Episodes in 2019

    In brief:

    • The proposed 2018 home health prospective payment system (HH PPS) includes an $80 million reduction in payments—a 2% drop from 2017
    • CMS will shift to a new payment methodology in 2019 that would establish 30-day episodes of care instead of the 60-day episodes currently used, and eliminate therapy service use thresholds in favor of payments more focused on clinical characteristics and patient information
    • 2019 changes could result in an estimated $950 drop in payment
    • Additional quality-reporting requirements to be added in 2020: skin integrity, falls, long-term care hospital patient functional assessments/care plans

    The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule for the 2018 Medicare home health prospective payment system (HH PPS) that would continue a planned series of cuts that began in 2014, with an estimated overall 0.4% reduction, or about $80 million, scheduled for next year. The proposal, released on July 25, also includes a plan to adopt a new payment model in 2019 that would shift from 60-day to 30-day payment episodes and lead to a nearly $1 billion reduction in home health reimbursements.

    Payment in 2018. The $80 million payment adjustment continues a set of reductions mandated by the Affordable Care Act, which began with a $60 million drop in 2015, a $260 million reduction in 2016, and $130 million for 2017. CMS arrived at the overall estimate by weighing a 2% payment increase against various decreases, mostly related to reductions in the 60-day episode payment rate and cuts to account for nominal growth in case mix.

    Episodes of care in 2019. In 2019 CMS would adopt a new payment methodology, known as the Home Health Grouping Model (HHGM), that would change the unit of HH payments from 60-day episodes of care to 30-day episodes of care. According to an article in Modern Healthcare, the change is based on a CMS analysis that concluded that the average length of home health care was 47 days, "but roughly a quarter of all 60-day episodes of care lasted 30 days or less."

    Therapy service use thresholds in 2019. Also part of the HHGM: the removal of therapy service use thresholds that CMS uses to make case-mix adjustments to HH payments. Instead, CMS would "rely more heavily on clinical characteristics and other patient information to place 30-day periods of care into meaningful payment categories," according to a CMS fact sheet on the proposed rule. Combined with the switch to 30-day episodes of care, CMS estimates that the adoption of the HHGM would result in a payment reduction of $950 million in 2019.

    Quality reporting in 2020. CMS is proposing the addition of 3 assessment-based quality measures beginning in 2020: changes in skin integrity postacute care; percent of residents experiencing 1 or more falls resulting in a major injury; and percentage of long-term care hospital patients who receive functional assessments at admission and discharge, as well as a care plan that addresses function.

    General comments on Medicare. As in previous proposed rules, CMS also seeks input on how the overall Medicare system might be improved—an offer APTA took up in its comments to proposed rules earlier this year.

    APTA regulatory affairs staff is reviewing the proposed rule and will submit comments on it to CMS by the September 25 deadline.