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Many insurance companies are now requiring people with back pain and other musculoskeletal conditions to see a physical therapist prior to approving payment for advanced diagnostic imaging. This trend is gaining momentum, and there are good reasons why this is happening.

First, there have been documented reports of innovative models of healthcare, such as the Virginia Mason pilot project1 whereby cost savings have been realized when people with certain health conditions are seen early in their course of care by physical therapists. These models have been implemented primarily for low back pain because of the high costs associated with managing back pain. At Virginia Mason Medical Center, in Seattle Washington, when they analyzed costs associated with the old model of back care, which was rather haphazard and often resulted in delayed care, with a new model that directed people to physical therapists early on, they discovered significant cost savings. In fact, costs decreased from and average of $2,100-$2,200 per person to an average of $900-$1,000 per person. Some of these savings were due to a substantial reduction in the use of MRI.

Parallel to the development of these innovative models of care is a growing pool of evidence that well-timed physical therapy intervention reduces the cost of low back pain diagnosis and treatment2. There have been several published research reports on cost effectiveness of back pain treatment. We are learning that when physical therapy treatment occurs fairly soon after someone develops symptoms, the total cost of care is less than that associated with the current standard of care. The primary reason for this is that when people do the relatively simple things early, they do not need the more expensive things (like MRI’s, injections and surgery) later.   

It is important to understand that when someone has an acute onset of back pain, there are criteria that help healthcare professionals determine if an MRI or other diagnostic test is warranted. Physical therapists are among those healthcare providers that know when diagnostic imaging and physician referral is warranted. Further, people can go directly to a physical therapist in New York State without the need for physician referral. As experts in movement health, physical therapists are able to help people with back pain harness their own body movements to actually facilitate healing and restore normal movement function. These same general concepts apply to many other musculoskeletal conditions that cause joint or soft tissue pain.   

So there is a good reason for seeing a physical therapist before the MRI…

1 Fuhrmans V. Withdrawal treatment: a novel plan helps hospital wean itself off pricey tests. The Wall Street Journal. January 12, 2007.

2 Fritz, Julie, John Childs, and et al. "Primary Care Referral of Patients With Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and Costs." Spine. Lippincott Williams & Wilkins, Inc., 26 Mar 2012.

Marcia Miller Spoto, PT, DC, OCS

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