What Insurance Companies Need to Know About PT as a First Touch

Americans are in pain, and with so many options on the market for pain management, it can be difficult to identify and pursue the best route of care. Here’s the truth—the majority of patients who are diagnosed with musculoskeletal pain are eventually referred to a physical therapist. Unfortunately, by the time they’ve been passed along between primary care physicians and specialists, given costly MRIs, and issued pain medications, the pain may have increased--along with their medical bills.

What does this mean for insurance companies? How does entry point of care affect healthcare costs? And where should patients in pain turn first? Below, we’ve done the heavy lifting for you to get to the bottom of these important questions.

Lowering Healthcare Costs: Why Entry Point Matters

Let’s use back pain, one of the most common diagnosis reported in the US healthcare system today, as an example. Back and neck pain are currently the 3rd largest condition for healthcare spending. In the US alone, we’re spending 88 to 90 billion healthcare dollars annually on the treatment of back pain.

There are multiple entry points of care for patients with low back pain, including family practitioners, chiropractors, physical medicine and rehabilitation specialists (physiatrists), physical therapists (PT), orthopedic surgeons and emergency departments. One recent study showed the following distribution for entry points of care: 55% primary care, 11% physiatry, 28% chiropractic and 6.4% physical therapy.

Depending on the entry point of care, these patients had different risks for additional costs and procedures. The patients who accessed physiatry first had increased utilization of radiographs, advanced imaging, injections, and surgery. When patients accessed chiropractic care first, they had decreased risk for advanced imaging or a surgical consultation, but experienced increased care duration. Those who accessed PT first had decreased risk for radiographs and zero chance of undergoing surgery.

Physical therapy helps patients improve symptoms faster with less associated costs.

The entry point of care can also have an impact on overall healthcare costs. A 2015 study of 2,289 patients with Medicaid in Utah who sought care for low back pain showed the following distribution for entry point of care:  71% primary care, 18% emergency department, 4% physiatry, 3.3% physical therapy. Entering care in physical therapy was associated with lower overall costs with the average costs distribution per entry point as follows: $900 emergency department, $770 physiatry, $533 primary care and $335 physical therapy.

Physical Therapy as a First (And Last) Touch

The questions is—would these patients (and their insurers) be better off skipping the middleman and going straight to physical therapy? We believe the answer is a resounding YES. Here’s why insurance companies should be encouraging patients in pain to turn to physical therapy as a first touch of care:

Lower Costs & Risks (for Patient and Insurer!)

The majority of patients with musculoskeletal pain end up receiving MRIs—but is this the most effective and efficient method of care? Not necessarily. Diagnostic imaging is not only expensive, it’s often inaccurate. Unlike an MRI, physical therapy can address the root of for the patient's symptoms and offer immediate steps towards improvement.

Reduces Need for Further Healthcare

Physical therapists are trained to do more than simply solve the pain or treat the complaint. They are also highly focused on preventative care, and empowering patients to avoid injury down the road. Rather than simply providing pain relief, physical therapy empowers patients to stay well for a lifetime.

Better Outcomes for Patients

According to research, early physical therapy intervention has benefits over delayed physical therapy intervention. Patients who turn to physical therapy as a first touch heal faster, spend less money, and have higher levels of satisfaction. This means PT as a first touch produces happier and healthier patients. Patients who are independent, free of pain, and not reliant on ongoing care or pharmaceuticals.

So, what’s preventing patients from pursuing PT as a first touch? In many cases, it’s high out of pocket expenses. For example, a visit to the doctor and a prescription for an opioid typically has a lower out of pocket expense to the patient than an episode of physical therapy where the patient pays a deductible amount, copay or coinsurance for each visit. Insurers can help remove the barriers to entry by advocating for direct access, educating their customers about the benefits of physical therapy, and implementing a PT first program.

Have questions about this? Luna is committed to helping patients get the best, most cost effective care faster by lowering the barrier to PT entry.  Learn more about Luna and our commitment to superb care.