Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. This surprises a lot of people.
Why is it so expensive? The first reason is that it’s so common. The second reason is that our current system isn’t very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. That’s because research has shown that early PT leads to better outcomes and lower costs. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain published in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for low back pain treatment.
A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls “high value” treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go back for more. TRICARE’s data seems to indicate that it will work. In a press release they state that once people attend one session of physical therapy, they’re likely to go back for more, no matter what their co-pay is. But TRICARE also found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That’s about half the rate of attendance found in the lowest co-pay group.
The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.
Source: The Private Practice Section of the American Physical Therapy Association Founded in 1956, the Private Practice Section of the American Physical Therapy Association champions the success of physical therapist-owned businesses. Our members are leaders and innovators in the health care system. The American Physical Therapy Association (APTA) represents more than 85,000 physical therapists, physical therapist assistants and students of physical therapy nationwide. For more information, please visit www.ppsapta.org.