Better PT Access Leads to Better Outcomes.
Because of School of Public Health research, a major insurer has changed its benefits to make it easier for patients to access physical therapy and chiropractic care for low back pain.
Research published in the journal Physical Therapy is the newest of three studies by the team, finding that unrestricted direct access to physical therapy leads to less health care utilization and lower costs. The other two studies found that insurance policies affect the likelihood that someone with low back pain will go straight to a physical therapist or chiropractor for treatment rather than a primary care physician (PCP), and that going straight to a physical therapist or chiropractor reduces opioid prescriptions.
The research has led UnitedHealthcare to introduce a new benefit where patients do not have to pay for their first three visits for physical therapy or chiropractic care to treat low back pain.
“This is a wonderful outcome of our work, which will likely shape the way consumers of care make their own choices regarding which provider to see,” says Lewis Kazis, professor of health law, policy & management, who served as senior author of the most recent study, and senior and lead author, respectively, of the other two studies.
Kazis and colleagues conducted the research with OptumLabs, which provided claims data on a study cohort of nearly 60,000 patients who had new-onset low back pain between 2008 and 2013 (OptumLabs is part of UnitedHealth Group.).
For the newest study, the researchers compared health care utilization among individuals who first saw a physical therapist for low back pain in states with unrestricted access to physical therapy and in states with provisional access. The researchers found that the individuals in states with only provisional access were billed for more health care utilization within 30 days, such as getting X-rays and visiting physicians more frequently.
The researchers then compared low back pain–related costs among patients who first saw a physical therapist and those who first saw a PCP for the condition. In provisional-access states, patients who went to PT first had 25-percent higher costs at 30 days and 32-percent higher costs at 90 days than those who saw a PCP first. But in states with unrestricted access to PT, patients who first went to PT had 13-percent lower costs at 30 days and 32-percent lower costs at 90 days than those who first saw a PCP.
All together, Kazis says, the three studies show that easier access to PT and chiropractic care for low back pain leads to patients seeking such care first, rather than going to a PCP first, and that doing so reduces health care utilization, costs, and opioid prescriptions.
The lead author of the most recent study was Brigid Garrity (SPH’18), who was a master’s student during the research. The study was co-authored by Omid Ameli, an SPH doctoral student and OptumLabs visiting scholar; James Rothendler, assistant professor of health law, policy & management; Kathleen Carey, professor of health law, policy & management; Howard Cabral, professor of biostatistics; Michael Stein, professor of health law, policy & management; Robert Saper, associate professor of epidemiology; and Christine McDonough of the University of Pittsburgh.
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