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Value of PT: Insurance Companies Encouraging More people to Get Physical Therapy.

Value of PT: Insurance Companies Encouraging More people to Get Physical Therapy.

PT is Highly Valued
Value of PT: Insurance Companies Encouraging More people to Get Physical Therapy.

TRICARE, one of the nation’s largest insurers wants its members to get physical therapy for back pain. They think that treating back pain with PT is so important that they’re willing to waive the cost to their members. That’s a huge deal. When’s the last time you remember an insurance company covering the entire cost of anything?

Let’s dive into back pain treatments and see why TRICARE likes PT so much.
You probably already know that back pain is a common problem. What you might not know is that the medical system isn’t very good at treating it.

“Non-drug treatments like physical therapy” are the first treatment recommended for back pain.

Unfortunately, many providers don’t follow this, and treatments are often recommended based on opinion rather than research.

This means insurance companies and patients often end up spending a lot of money on outcomes that are less than stellar.

Lowering Cost of PT
Here’s how it usually goes:
You go see your doctor with back pain.

They might give you medication, recommend rest, some stretches, send you for x-rays or an MRI.

Next will likely be a referral to a specialist like an orthopedic surgeon.

Chances are you won’t be having surgery right away, so the specialist will either refer you to PT or back to your PCP where you’ll end up with a PT referral.

The path will look different for each person, but the end result is usually the same – multiple failed treatments, imaging you probably didn’t need, and a delay of weeks or months to get to a physical therapist.

Multiple large studies have looked at the effects of early physical therapy on low back pain with impressive results.
Low cost to PT
One of them was done in 2006 in Seattle by Virginia Mason Health Center. They teamed up with Aetna and Starbucks to send workers with back pain to see both a physical therapist and physician for their first treatment. The use of MRI dropped by 1/3, people got better faster, missed less work, and were more satisfied with their care. The cost savings were so great, that Virginia Mason was losing money on treating back pain and Aetna ended up paying them more for PT treatments because Aetna was saving so much money.

Intel ran a similar program with their employees, getting people with back pain to a PT within 48 hours. Previously it took about 19 days for people to get to a PT. With the earlier access, patients completed their care in 21 days, compared with 52 days previously, and costs dropped between 10 and 30%. Intel also found more satisfaction with care and a faster return to work.

The data is out there proves physical therapy is the cheapest and most effective treatment for most people’s low back pain.
It’s clear that people with back pain should start treatment with their physical therapist, but most don’t. TRICARE’s pilot program that waives copays for up to three PT visits aims to change that. If successful it will lead to lower costs for both TRICARE and their members while delivering better outcomes in less time. Currently, Molina makes sure their members start PT for their musculoskeletal injuries before they get any other type of treatment such as pain injections. By following such protocols, insurance companies are ensuring earlier access to PT to avoid prolonged disability.
Lowering Cost of PT
With the success of TRICARE’s initiative to encourage PT for their members, there is a good chance other insurance companies will come up with their own program so more people choose PT over other modes of treatment.
If you are suffering from pain and thinking to start PT, call us now to find out how your insurance might cover your PT treatment.

Do not delay your recovery by worrying about the cost. Take the first step to reduce your pain.

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Finally, Some Good News About Back Pain

Finally, Some Good News About Back Pain

 

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 is the single biggest cause for disability and the third most common reason for doctor visits.

It is one of the most common reasons for missing work.

Even locally in south-east Michigan, back pain is one of the most common condition that people suffer from.

In Sterling Heights, Michigan, where we are located, we have seen many patients suffering from back pain. Total cases of lower back pain is much higher than any other conditions people suffer from.

 

Back and neck pain makes up the biggest healthcare expense in the US

With higher number of cases of lower back and neck pain it is also very expensive.

Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016.

The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal.

Back pain won’t kill you, usually doesn’t require long term medication, and usually doesn’t require surgery either.

Then why is it costing this much to our healthcare system?

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. Research backs this up, showing better outcomes and lower costs with early PT.

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 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 treatment of back pain.

Current trends that we have noticed includes medications, followed by injections to treat back pain by the PCP and if that does not solve the problem may be patient will be referred to PT. 

A Major Reset is Needed to Change The Healthcare Mindset.

A major reset is required to change the healthcare practice and to treat back pain and other musculoskeletal conditions in general.

It is important that not only patients byut

 

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.

This is the “try it before you buy it” approach – think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works just as well for healthcare as it does for other businesses.

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 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.

Share your thoughts here by commenting. We will love to hear your thoughts. 

Are you suffering from lower back pain?

If you are suffering from back pain and trying to find your option.
Start by scheduling a free Discovery Visit now.

Just click on the link below and fill out a contact form or call us at (248)432-1618 and we will get in touch with you soon.

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