Tuesday, January 22, 2019 Study of Cash-Based PT Services Hints at Possibility of Increased Cost-Effectiveness A small-scale study that looks at the effect of cash-based physical therapist (PT) services on utilization points to the possibility that the approach could be associated with lower overall costs and greater patient-reported levels of improvement—although authors say more research is needed before any definite conclusions can be drawn. The new research, which authors describe as "the first to provide descriptive statistics for a cash-based PT clinic," involved chart review of 48 randomly selected patients who sought treatment from a Florida-based physical therapy clinic between 2013 and 2016. The clinic accepts only direct payment, and all patients sought treatment via the state's direct access provisions. Results were published in The Health Care Manager (abstract only available for free). In their analysis, the authors dispensed with codes from the International Statistical Classification of Diseases and Related Health Problems (ICD) and instead focused on affected body regions. They did, however, stick with the ICD definitions for acute (0 to 4 weeks' symptom duration), subacute (4 to 12 weeks' duration), and chronic (duration of more than 12 weeks) injuries. Patient self-reports were derived from the Numeric Pain Rating Scale (NPRS) obtained at evaluation and discharge. Male patients outnumbered female patients, 27-21. Average patient age was 41 for men and 47 for women. Here's what researchers found: The average number of visits per episode of care was 8, with a median of 5. Authors report that a similar study conducted with patients in a traditional insurance-based model identified a 7.3-visit average. Total cost of care for the cash-based practice averaged $780 (median of $600); the insurance-based study identified a total average cost of $936. Patients in the cash-based system averaged a per visit cost of $97.52. Patients seeking treatment for low back pain (LBP) made up the bulk of the case load, at 39.6%. The second most common diagnosis was leg or knee pain (29.2%), followed by cervical/thoracic pain (14.6%). Average patient NPRS score at evaluation was 6.9 (with a variation of plus or minus 1.9 points), and at discharge was 1.1 (plus or minus 1.9 points). In all cases, patients met the minimum clinically important difference for change in NPRS score. Chronic injuries accounted for 28 of the 48 injuries treated. The study's authors acknowledge its limitations, including the small sample size, its focus on 1 practice, and its use of descriptive statistics. While they write that the study "provides a foundation for further research," they caution against drawing conclusions about the cost-effectiveness of cash-based versus insurance-based PT services. Still, they argue, the study has uncovered some potentially compelling evidence that merits further study. "Our data supports the possibility of increased cost effectiveness when compared with traditional insurance-based PT services," authors write. "Fee schedules and outcome measures used when comparing outcomes across multiple cash-based services are necessary areas for future research to be able to fully compare cash-based practice to insurance-based services." APTA members Kyle Pulford, PT, DPT; Brittany Kilduff, PT, DPT; William Hanney, PT, DPT, PhD; Morey Kolber, PT, PhD; and Ron Miller, DPT, were among the authors of the study. [Editor's note: Interested in cash-based practice? Check out APTA's Cash Practice webpage for background information, tips, and FAQs.] 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.