Despite published guidelines that call for physical therapy or medications such as ibuprofen or acetaminophen for first-line management of most back pain, other treatments such as imaging, narcotics, and referrals to other physicians have increased, according to a study published online yesterday in JAMA Internal Medicine.
Because more than 10% of visits to primary care physicians relate to back and neck pain, and the treatments recommended by guidelines generally are less costly than those being used increasingly, the financial implications in the health care market are significant. "With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care," the study concludes.
The study identified 23,918 visits to primary care physicians for spine problems. Average age of the patients increased from 49 to 53 years during the study period, January 1999 through December 2010, and 58% of the patients were female.
According to the results, physical therapy referrals remained unchanged at about 20%, but physician referrals increased from 6.8% to 14%. Nonsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9% to 24.5%, while narcotic use increased from 19.3% to 29.1%t. The number of radiographs remained at about 17%, but the number of computed tomograms or magnetic resonance images increased from 7.2% to 11.3% during the study period.
A new Maine law will give physical therapists and other health care providers additional protections when they enter into contracts for preferred provider arrangements. Public Law 399 (LD 1466) will require health plans to disclose certain information and materials to providers at the time a preferred provider arrangement contract is offered.
The legislation will prohibit contracts that allow health insurance companies to make changes to key terms, such as reimbursement rates, without the provider's written consent after the agreement has been entered.
LD 1466 was sponsored by Maine Senate Majority Leader Seth Goodall (D-19) and supported by the Maine Chapter of APTA. The new provisions will take effect October 8.
APTA answers members' most-often-asked questions about coding for patient education services in a new APTA.org resource. The members-only FAQ addresses questions such as "How do physical therapists report (bill) time spent delivering patient education" and "What should be included in documentation about patient education?"
As APTA reported on July 9, physical therapists and other health care providers have a chance to rate their Medicare Administrative Contractors (MACs), and the Centers for Medicare and Medicaid Services (CMS) is still seeking registrants for this opportunity.
CMS's new provider satisfaction measuring tool, the MAC Satisfaction Indicator (MSI), will ask participants to rate their Medicare administrative contractors (MACs) in areas such as claims processing, Medicare enrollment, education offerings, and responsiveness to inquiries.
CMS will choose participants at random from registered Medicare fee-for-service providers. APTA encourages members to join the registry and if selected provide feedback-CMS and the MACs will use the results of the MSI to improve their service to all Medicare fee-for-service providers.
Click here to go directly to the registration form, or visit the Medicare Contractor Satisfaction Indicator webpage for more information.
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