By: Brady Hill, CEO
At Cypress Health Partners, we’re committed to building a better model for musculoskeletal (MSK) health. We believe MSK healthcare is broken, and we’re here to help fix it. Our communities and patients deserve a better care model, one that is more than episodic and focused on prevention, with high quality outcomes, and early access to care that doesn’t end with discharge.
In our vision of Physical Therapy First, physical therapy is the first stop on an MSK patient’s care journey, not the last. Through outcomes data and years of patient interactions, we know that this approach achieves the best patient outcomes and experience at the lowest cost. But you don’t have to take our word for it, the facts speak for themselves.
The direct annual cost of MSK conditions is estimated to be in excess of $381 billion, representing the single largest health category in the United States — and also the fastest growing. Much of this increase can be attributed to the increased utilization and per unit costs of expensive diagnostics and invasive procedures. Notably, the per unit cost of inpatient spinal fusion increased by 89% from 2010 to 2019, and the cost of MSK related emergency room visits increased by 155% during the same period.[1]
If this increase in spending translated to better overall MSK health in this country, perhaps the money would have been well spent. But it hasn’t. As Americans have spent more money, the number of MSK claims continues to rise. Procedures like spinal fusion have yet to be associated with long-term benefits, and expensive diagnostics like MRIs can lead to delays in care that can exacerbate conditions and cause unnecessary pain for patients.
When patients are able to get direct access to physical therapists — that is, when they see a physical therapist first after the onset of pain or injury— the picture improves dramatically. A recent study from Georgetown and Johns Hopkins concluded that when patients have direct access to PTs, the cost of their care is 2.2 times lower than when they see a physician first. Additionally, when patients see a physician first, their episode of care is 65% longer than those who have direct access to PTs.[2] Another study published in Military Medicine found that direct access to PTs for soldiers decreased the use of radiology compared to when they saw a primary care physician (PCP) first (11% with PTs vs. 90% with PCPs) and decreased the use of pain medication (24% vs. 90%), with a 50% higher return-to-duty rate.[3]
Some argue that patients who skip a physician’s referral when seeing a PT first run the risk of injury or an overlooked diagnosis, but the data doesn’t support that concern. A study published in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) examining more than 50,000 patients with direct access to PTs reported not a single incidence of a patient injury or an adverse event from patients seeing a PT before a physician. In fact, according to the CDC, far from having adverse effects, a PT First approach has been shown to be highly effective at treating and reversing the underlying cause of many types of chronic pain, resulting in reduced pain and improved function “immediately after treatment” with the healing sustained over time. Because of the effectiveness of a PT First approach, patients who are able to get direct access are also prescribed far fewer opioids. A study in Evidence in Motion estimates that a PT first approach results in patients being 75-90% less likely to have short and long-term exposure to opioids. And when the circumstance arises in which a patient isn’t a good fit for physical therapy, the physical therapy evaluation process ensures that patients are appropriately referred to a physician.
Although the data and the experiences of patients should convince payers to support the PT First approach to MSK care, we recognize that systemic change is hard. At Cypress Health Partners, we are dedicated not only to enhancing the standards of care for all our patients, but in working toward our vision where the PT First approach is the standard of MSK care.
To that end, we have embarked on an extensive research initiative among our more than one hundred clinics to help quantify the benefits of the highest standard of care using the most-up-date clinical guidelines. We believe that this is the most ambitious research project of this scale in the United States. As the research progresses over the next few years, we’re excited to share the results with our patients, other providers, researchers, and the people best positioned to move the needle toward the vision of PT First: payers. In the meantime, please share your comments or any research you are aware of in this area, in the comments below.