Study Spotlight: Initial Consultation with PT Provider May Reduce Healthcare Utilization in Patients Seeking Care for Neck Pain

Study Spotlight: Initial Consultation with PT Provider May Reduce Healthcare Utilization in Patients Seeking Care for Neck Pain

For patients with a new episode of neck pain, initially consulting with a nonpharmacological provider (physical therapist or chiropractor) may decrease opioid exposure.

Neck pain is an immense physical, social and economic burden, regarded as a major public health problem. In fact, half of all individuals will experience a clinically important episode of neck pain at some point in their life, and 80% of those people eventually seek care. Despite this prevalence, there has been no consensus on the type of provider a patient should see first for care—a key indicator of downstream healthcare utilization. On top of that, there are the ever-present dangers of opioid addiction, which has been identified as a public health epidemic.

To address these problems, a study published in the Mayo Clinic Proceedings: Innovations, Quality & Outcomes journal aimed to determine the connection between the type of provider initially consulted and 1-year, downstream healthcare utilization to inform future care recommendations.

In the study, Horn et al investigated a retrospective cohort of 1,702 patients with a new episode of neck pain over a 1-year period. The researchers then separated those patients into groups based on who they consulted first: primary care provider (PCP), physical therapist (PT), chiropractor (DC), or a specialist.

The study found that the practitioner consulted at the index visit for neck pain can have an impact on downstream healthcare utilization. More importantly, the researchers found that, when compared to an initial neck pain consultation with a PCP, an initial consultation with a nonpharmacological provider (DC or PT) is associated with a decrease in opioid use 30 days and 1 year after initial consultation.

These findings are consistent with recent guidelines, which favor nonpharmacological interventions. In light of the opioid addiction epidemic, stronger alignment of PTs and DCs as front-line providers by healthcare systems may be needed.

MedRisk’s PTConsult services support this goal by proactively identifying and solving for issues through a telephone consultation and screening process. PTConsult takes or recommends the best course of action to eliminate obstacles to recovery and reduce total claim cost and healthcare utilization.

To read the full article, click here.

Horn ME, George SZ, and Fritz JM – Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain
Mayo Clin Proc Innov Qual Outcomes. 2017 Dec; 1(3): 226–233.

Study Spotlight: Physical Therapists Are Essential to Support Patients Self-Managing Musculoskeletal Disorders

Physical therapists can empower patients with chronic musculoskeletal disorders by supporting effective self-management.

Persistent musculoskeletal disorders—including spine-related neck and back problems—are painful to patients and costly for workers’ compensation payers and society as a whole. Among occupationally active adults, musculoskeletal disorders are the main causes of disability. Often work related, they can lead to lost time and reduced productivity.

Biomechanical and psychosocial risk factors often influence musculoskeletal disorders. That’s why, as an article published in the Journal of Orthopaedic & Sports Physical Therapy argues, a person-centered approach focusing on self-management strategies is so essential to helping patients restore and maintain function.

In the paper, Barlow et al outline the physical therapist’s (PT) role in supporting effective self-management. The authors define self-management as “the ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition.”

As experts in musculoskeletal disorders, PTs are ideally positioned to provide self-management support that focuses on teaching skills that patients can use to manage these conditions on their own. In this approach, PTs help patients understand their conditions and the biomechanics of them while promoting behavioral changes and active lifestyles.

PTs help patients develop a patient-preferred approach to physical therapy exercises to improve function and strength, reduce pain, and increase well-being. The goal is for the patients to develop their own strategies to reducing their symptoms. Techniques may involve exercise, pain management, cognitive behavioral therapy, shared decision-making, acceptance, problem-solving and/or mindfulness, and other techniques. It’s all very individualized.

With self-management, PTs provide support as the patients set goals, recognize barriers to achieving them and learn how to measure the effectiveness of their own self-management. This provider-patient partnership is an essential component of this approach.

As the leading provider of managed physical medicine for the workers’ compensation industry, MedRisk stays abreast of industry trends such as this. By so doing, we continue providing our carriers, TPAs and employers access to the best national network of credentialed PTs in the workers’ compensation industry.

To read the full article, click here.

Promoting the Use of Self-management Strategies for People with Persistent Musculoskeletal Disorders: The Role of Physical Therapists
Nathan Hutting, Vernerian Johnston, J. Bart Steal, and Yvonne F. Hearkens
Journal of Orthopaedic & Sports Physical Therapy 2019 49:4, 212-215
Study Spotlight: The Influence of Physical Therapy Guideline Adherence on Healthcare Costs for LBP Patients

Study Spotlight: The Influence of Physical Therapy Guideline Adherence on Healthcare Costs for LBP Patients

Adherence to established clinical practice guidelines could reduce high downstream healthcare utilization.

Musculoskeletal pain as a whole is a common and costly health condition. Up to 84% of the general population will report at least one episode of low back pain (LBP) at some point in their life. This high rate of LBP treatment also has high downstream costs. An article published in PLOS One systematically reviews a collection of peer reviewed studies to evaluate the influence of physical therapy guideline adherence on healthcare utilization and costs for LBP patients.

Hanney et al conducted an electronic search across various peer-reviewed journals to assess current evidence on how guideline adherence affects LBP costs. The authors identified seven primary factors for healthcare utilization and costs:

  1. Number and duration of PT visits
  2. Prescription medication use
  3. Physician office visits
  4. Emergency department care
  5. Advanced imaging
  6. Surgical procedures
  7. Injection procedures

With some exceptions, the review showed that those participating in an adherent PT treatment program experience lower healthcare utilization. This includes fewer and shorter PT visits, fewer medications, fewer visits to the physicians or emergency department and less use of advanced imaging, surgical, and injection procedures.

While further research is needed to provide firm evidence on the impact of guideline adherence among patients with LBP, this preliminary evidence is a great step towards optimized effectiveness and efficiency in value-based healthcare systems.

That’s why MedRisk invested in the development and on-going maintenance of physical medicine specific evidence-based treatment guidelines. These guidelines take into consideration chronicity (the age of the injury), complexity (multiple body parts and/or comorbidities), severity and surgery. They also address the best  treatment choice, timing, and sequence of interventions. Their specificity make them a valuable supplement to ODG, ACOEM, and state-specific guidelines. MedRisk’s proprietary guidelines, developed and maintained by our International Scientific Advisory Board, allow us to proactively identify cases that may be trending off track and support clinical decision-making—ultimately eliminating unnecessary downstream utilization and costs.

To read the full article, click here.

Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature. PLoS One. 2016 Jun 10;11(6):e0156799. doi: 10.1371/journal.pone.0156799. PMID: 27285608; PMCID: PMC4902217.

Q2 2021 Legislative Updates

Here is a summary of legislative and regulatory developments and challenges for the second quarter of 2021 and their practical implications:

California MPN Legislation: Two bills that posed significant challenges to California’s Medical Provider Network (MPN) system have been defeated, at least for now.

Assembly Bill 399 would have mandated that MPNs pay participating providers at California’s Official Medical Fee Schedule and would have prohibited negotiated rates below the regulatory fee. The measure would also have restricted MPNs’ ability to review provider bills for mistakes, fraud and abuse. Through intense opposition by employers and WC payers, the bill was held in the Assembly Insurance Committee without being voted on and, as a consequence, is ineligible for further consideration until the next legislative session.

Assembly Bill 1465 would have required the Division of Workers’ Compensation to establish a state-run MPN (CAMPN) and would have permitted injured workers to select providers from this network in lieu of their employers’ MPNs. This measure is now a “study bill,” meaning that the California Commission on Health and Safety and Workers’ Compensation (CHSWC) will compare treatment delays and provider access issues between MPN and non-MPN claims and issue a report of its findings by January 1, 2023.

Implications: It is unlikely that either of these bills will be resurrected in the foreseeable future. Unlike SB 537, a similar measure that was enacted in a weakened form in 2019, AB 399 failed to gain any traction during the current legislative session, due in large part to the immediate increase in WC medical costs forced by the measure’s prohibition of network discounts. AB 1465 also met strong opposition from the business community, and the CHSWC study likely will counter the arguments of AB 1465 proponents that California injured workers lack access to high quality medical care via MPNs.

Arizona Telehealth Legislation: On May 5, Governor Doug Ducey signed into law HB 2454, which provides broad support for telehealth services in group health coverage. The measure clarifies existing law that Arizona endorsement of telehealth encounters applies to ancillary services and requires a carrier to reimburse health providers at the same level of payment for equivalent services, regardless of whether the services are provided in-person or via audio-visual telehealth.

Specifically in relation to workers’ compensation, the law allows medical examinations for workers’ compensation claims to be conducted via telehealth with the consent of both the employee and the requesting party.

Implications: HB 2454, which was effective on its enactment, continues the broad trend toward state endorsement of telehealth when those services are medically appropriate. WC payers should incorporate telehealth into their injured worker treatment options if they haven’t done so already.

Study Spotlight: Exploring the Issue of Psychosocial Factors in LBP

Psychosocial factors—including fear of movement and anxiety about the future—are an expected and normal part of LBP experiences.

Low back pain (LBP) interventions are often categorized as “physical” or
“psychological,” creating a potential barrier to recovery in some patients who may be inhibited by these psychosocial factors. An article published in the British Journal of Sports Medicine challenges this separation, stating that understanding and addressing psychosocial factors in clinical practice can help better optimize patient management.

In the research, O’Keeffe et al investigated how psychosocial factors do not always indicate mental health disorders and are not distinct from biological factors. Reductions in pain and disability after treatment are, to some degree, facilitated by changes in non-physical factors, like self-efficacy. For example, exposure to a specific movement that the patient fears paired with an empowering narrative from the provider can reduce the associated fear or anxiety.

The study also argued that psychosocial factors do not only appear in persistent pain presentations. In fact, the authors, who included Steven Z. George, PT, PhD, FAPTA, a member of MedRisk’s International Scientific Advisory Board (ISAB), said that psychosocial factors are an expected and normal part of LBP experiences, acute or chronic.

Psychosocial factors may be just as important to consider as “other factors” when a patient “fails” during “normal” treatment. Exploring and addressing these factors at the front end will ultimately drive more successful patient outcomes. This research supports MedRisk’s PTConsult, a service that makes adjusters aware of any psychosocial factors and provides patient education on the importance of physical therapy, treatment expectations and any perceived barriers to recovery (including anxiety).

To read the full article, click here.

O’Keeffe M, George SZ, O’Sullivan PB, et al Psychosocial factors in low back pain: letting go of our misconceptions can help management. British Journal of Sports Medicine 2019;53:793-794.