Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Direct Physical Therapy Access Could Reduce Healthcare Costs

A policy brief from the Health Care Cost Institute reports that Individuals with lower back pain who received physical therapy had reduced healthcare costs.

When it comes to healthcare costs, the federal government, medical providers, and payers are attempting to reduce rising spending and adopt value-based care reimbursement.  A number of different strategies have been implemented including bundled payment models and accountable care organizations. In the realm of physical therapy, patients with lower back pain could benefit from reduced healthcare costs.

Physician Self-Referral

A policy brief from the Health Care Cost Institute reports that Individuals with lower back pain who received physical therapy had reduced healthcare costs when compared to patients who visited with another provider first. Patients who visited a physical therapist at the beginning of their treatment were less likely to end up in an emergency room. A lower likelihood of emergency department visits also produces hospitalization costs.

Since low back pain is a very common occurrence in the healthcare setting and a likely contribution to disability, these findings are key to reducing medical spending across the industry. In fact, $90.6 billion in direct healthcare costs are spent on treating back pain throughout the United States.

The study authors focused on analyzing beneficiary claims data from six states including Oregon, Washington, Wyoming, Alaska, Idaho, and Montana. The researchers  looked at claims data  showing three different groups of people including those who never saw a physical therapist, those who saw a physical therapist later in their treatment, and those who immediately received physical therapy.

The study found that patients who saw a physical therapist first were also less likely to be prescribed a painkiller when compared to others who saw a different type of clinician. The policy brief emphasizes that visiting with a physical therapist first will reduce the use of costly healthcare services and thereby cut spending across the board.

Researchers from the University of Washington and the George Washington University also found that taking away state restrictions on physical therapy could improve health outcomes among those on opioid prescriptions as well as enhance imaging. Individual states should consider addressing restrictions on direct physical therapy access, according to the policy brief.

State restrictions on physical therapy access could affect overall healthcare costs by impacting the use of differing medical services. Essentially, in order to reduce healthcare costs, state policymakers should allow patients direct access to physical therapy without physician referral, according to the study.

“The findings from this study suggest that seeing a physical therapist as the first point of care compared to seeing a physical therapist at a later point in time (or not seeing a PT) reduces utilization of potentially costly services,” the study from the Health Care Cost Institute stated.

“Of particular interest was the significant decrease in opioid prescription, ED visits, and imaging for those patients receiving PT first. The potential reduction in opioid prescriptions is notable given the increasing awareness on the overprescription of opioids and the high risk of substance abuse. These findings suggest that having access to PT could have an impact on healthcare costs including out-of-pocket costs across all settings.”

While reducing healthcare costs is an imperative within the medical industry, quality care and patient needs come first. However, a study from the American Physical Therapy Association shows that patient needs may not come first in a referral-for-profit environment.

The study illustrates that patients who obtained physical therapy services from a clinic owned by their original physician received twice as many PT visits as compared to patients who were referred to physical therapy not affiliated with the referring surgeon. The therapy was also less customized and less intensive, the researchers found.

“When there is referral-for-profit, and from this data as related to group therapy and an extended number of visits, it stands to reason there is increased risk that the patient’s individual needs are of secondary importance to revenue. This has long been the concern here at the American Physical Therapy Association (APTA) and it is why we have fought so hard, alongside our partners in the AIM Coalition, against physician-owned physical therapy services (POPTS),” American Physical Therapy Association President Sharon Dunn, PT, PhD, OCS, stated in a press release.

“This study provides further evidence that when the bottom line takes precedence in healthcare, the patient loses. A patient’s welfare and recovery should always be the primary focus of treatment.”

The researchers looked at more than 3,000 patients who underwent total knee replacement surgery. Out of all of these, nearly 19 percent were found to be completed through a physician self-referral process while 72.3 percent of cases did not have a doctor who had “ownership interest in physical therapy services.”

The findings show that treatment in a physician-owned physical therapy setting lasted a week longer than services not affiliated with the referring physician. About twice as many visits were seen in physical therapy offices in which the referring doctor had a financial stake.

The issue seems to be that, in physician self-referral cases, patients were more likely to receive group therapy instead of individual, one-on-one care, which tends to extend the amount of visits needed to complete treatment.

This type of physician self-referral practice may improve revenue for an individual physical therapy clinic, but it only increases overall healthcare spending and negatively impacts patient care, the researchers wrote. In order to meet the Triple Aim of Healthcare, providers will need to look beyond their own revenue cycle and consider patient needs first.

Image Credits: Health Care Cost Institute

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