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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. 

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