Do the right thing for LBP patients


Healthcare expense has been rising for the past decade, impacting all American consumers, hospitals and governments. It seems that the upward trending of healthcare cost will stay, at least for some time.

There are a lot of factors that impact on healthcare costs for Americans. If we dive into the detail of medical expense by different medical conditions, musculoskeletal, aka MSK, related medical expense is the 3rd largest category, next to cardiac and cancer treatments. Within MSK treatment, spine related medical expense accounts for about 70%. Spine related medical treatment is obvious a huge expenditure for American families and healthcare system.

The characteristic of spine related conditions is very different to cardiac and cancer treatments. Cardiac and cancer treatments rely heavily on medical centers. Those centers could be regional or national, those centers are all equipped with multi-million dollar equipment to do the operations. On the other hand, MSK treatments are widely distributed among many medical disciplines and non-medical professions.

MCOs (Managed Care Organizations) have been trying to bend the upward MSK related expense curve, or, at least, to keep this expense curve flat. This effort has not been very successful for all MCOs. From claim data analysis, there are several scenarios that contribute to MSK treatment as one of the largest expenses in healthcare:

  1. High prevalence of lower back pain (LBP) among Americans
  2. Wide varieties of point of entry to spine issues, some are not necessarily medical treatments.
  3. A relatively large portion of patients look for quick-fix for their spine issue, but they do not realize that spine related issue could be very complex
  4. Incorrect handling of treatment and escalation at the Point of entry (PoE) for LBP treatment can easily make the episodic cost much higher. This could happen either by holding the patient too long for conservative treatments that do not show result, or by referring patients to other specialty providers too soon without proper conservative treatments.
  5. After patients get their MRI/CT scans, a relative high percentage of patients ended up with expensive injections to manage the unbearable pain or invasive surgery procedures.
  6. All the medications that patients use to make they feel better is another expenditure for patients.

So, what is the right approach for patients with lower back pain problem, if the spine care treatment is so complex? Physical therapists have to be the Point of entry (PoE) for all lower back pain patients.

Consumerism of Healthcare is Giving Physical Therapist the Opportunity to Step Up as The Point of Entry (PoE) for Lower Back Pain

All the white papers and discussion to date have been based on medical reimbursement data. Our premise is based on the following findings. 1..After studying social media data, which is the detailed comments from patients, we realized that there are a lot of LBP treatments happening before patients seek medical professional help. 2…for working Americans, high deductible health plans with Healthcare Saving Account (HAS) account (HDHP) are very common today. So, the treatments many LBP patients are seeking are all cash based. 3……HSA (Health Savings Accounts) spending is cash equivalent.

If physical therapists have not realized that, it is time to rethink your market approach strategy.

Furthermore, the deepest fundamental change is the consumerism or “Uberism” of healthcare. During the time with low deductibles, most clinical decisions were made by PCP (Primary Care Provider). But today, with a shift to a cost-sharing healthcare model, in which patients have to shoulder part of the cost many patients have to make decisions between what providers to see, how much money they can spend and on what type of service, when they will reach the deductible etc.

With the consumerism of healthcare progression and all the characteristic of LBP treatment, it makes perfect sense for Physical Therapists to be the PoE for LBP treatment. Physical Therapists can help patients to get the right solution for their long-term wellbeing.

All these great ideas will need patient engagement at the front-end.

Currently, most physical therapy clinics still rely on MDs’ referral for getting new patients. This current business model is not patient centric solution. It is HMO or health system centric solution, based on what MD think for patients. With the purchase decision power shifting to patient more, this approach is late in the treatment process for conservative treatment.

The right thing to do is patient engagement at the front-end. This requires addressing patients’ wants, answering patients’ questions about treatment, payment and insurance options. With strong clinical guidelines and referral process, Physical therapist can be the point of entry to put LBP patients on conservative care first before other expensive and invasive procedures. If Physical therapist can show as the PoE that this patient engagement does increase outcomes, patients, payers and physical therapists will all win.

By Richard Zhao and Jerry Durham. Originally published at

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