Physical Therapists as Primary Spine Providers

One of the anticipated outcomes of health care reform is an increase in the number of US citizens enrolled in health insurance plans. A potential consequence of increased enrolment may be a shortage of primary care physicians (PCP) to accommodate the increased number of insured individuals.

But there does not have to be a shortage of qualified health care providers in our new health care system. Let me explain.

Currently, PCP’s manage the overall health needs of their patients. Patients generally come to them first with their health problems; the PCP treats what they can at this entry level point, and refer to appropriate health care providers or medical specialists when needed. One thing we have learned over the past several years is that the clinical pathway (how people navigate through the health care system) has a big impact on costs.

When patient see their PCP for musculoskeletal complaints, the PCP may provide first-line treatment, which is frequently the prescription of NSAID’s. They can exercise one of several referral options if the problem is either more serious or if it persists. PCP’s do not have extensive training in musculoskeletal practice, so with more complicated problems, The PCP often refers their patients to orthopedic surgeons or other surgical specialists. This is true even if the patient does not require surgery. Specialist providers in particular drive up health care costs. Of course when specialists are needed this is acceptable, but when their expertise is not required to manage the condition effectively, these represent unnecessary costs.

A new, more efficient model of care is emerging right here in Rochester. Excellus BCBS is in the process of changing the clinical pathway for spine care. They have targeted back and neck pain because these conditions are significant cost-generators in the health care system. They are providing training for physical therapists and chiropractors to become primary spine providers. The common ground for these providers is that they are conservative practitioners. It is estimated that 95% of spine problems can be successfully treated with conservative care. This model will impact health care in 2 important ways: (1) it will unburden PCP’s and free them up to do what they do best, manage diseases and other non-musculoskeletal conditions, and (2) it will provide appropriate, cost effective treatment for back and neck pain.

This model has the potential to shift the clinical pathway for musculoskeletal care in general, and may eventually be adopted by other large communities. Rochester seems to be on the cutting edge for innovative, collaborative health initiatives that are designed to improve the health care system as a whole.

Marcia Miller Spoto, PT, DC, OCS