TRICARE, one of the nation’s largest insurers wants their 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.
The first treatment recommended for back pain is “Non-drug treatments like physical therapy”. Unfortunately, many providers don’t follow this advice and recommend treatments based on opinion, rather than research. This means insurance companies and patients often spend a lot of money for outcomes that are less than stellar.
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 looks 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.
So, can early referral to physical therapy make a difference?
Multiple large studies looked at the effects of early physical therapy on low back pain with impressive results. Virginia Mason Health Center did one study in Seattle in 2006. 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.
Patients being referred for MRI’s dropped by 1/3. People got better faster, they missed less work and were more satisfied with their care. The cost savings was so great, that Aetna ended up paying Virginia Mason more for the PT treatments because they were 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 19 days for people to get to a PT. With the earlier access, patients completed their care in 21 days. Previously, they took 52 days to complete their care. Costs dropped between 10 and 30% due to early access to PT. Intel also reports more satisfaction with care and a faster return to work.
The data is out there that 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.