Eliminating Out-of-Pocket Expense for Outpatient Physical Therapy

Eliminating Out-of-Pocket Expense for Outpatient Physical Therapy in Non-Surgical Low Back Pain: A Retrospective Analysis BACKGROUND/PURPOSE METHODS  Low back pain is highly prevalent (84% lifetime) and costly, with annual costs in the US exceeding $100 billion  Conservative therapies, including physical therapy, have shown positive impact across patient reported outcomes, cost measures, and avoidance of high-cost imaging, injections, and surgery  Despite the positive effects, health plan design across both commercial and government payers places barriers to physical therapy care through co-payments, increasing cost-sharing (deductible, co-insurance), visit limits, utilization review, and authorizations prior to treatment  In the presence of low back pain, individuals with more restrictive health care plans were less likely to choose conservative care and physical therapy intervention the chosen intervention in the presence of lower patient cost sharing. (Carey  Statistical Analysis: Data was analyzed using a mixed-effects linear model to account for the multiple measurements over time nested within patient trajectories.  Dependent variable in the analyses were: (a) the absolute score on the MLBDQ, and (b) the gain score on the MLBDQ compared to baseline score measured at admission.  The independent variables used were sex, time since intake visit, time between injury and first visit, the disability rating at baseline, and whether or not the patient was covered by UHP/NUHP.  Models were examined with main effects, and 2and 3-way interactions of terms. The most parsimonious models with significant predictors were retained. RESULTS et al, 2019)  To our knowledge the influence of out-of-pocket expense on patient reported outcomes has never been presented in the literature.  The purpose of this study is to compare outcomes of pain and disability in two similar payer groups, one with all out-ofpocket expenses eliminated. 316 cases with 2 or more Visits Figure 2: Improvement of MDQ by visit Figure 3: Improvement MDQ time to PT Std. Error t value (Intercept) 75.1434840 1.6751585 44.857536 Admission Outcome Score -0.8829724 0.0171742 -51.412761 1.1999572 0.1409483 8.513457 Time to initiate -0.0210859 0.0144774 -1.456471 BU.BCBS -1.6457433 1.2950224 -1.270822 Admission Outcome Score x weeks Weeksx Time to initiate -0.0096963 0.0017172 -5.646717 -0.0030080 0.0007400 -4.064895 0.2402173 0.0643158 3.734968 weeks Weeks x BUBCBS Table 2: Two-way Interaction predict improvement baseline score by visit UHP (BUBCS) 330 New Evaluations with Lumbar Complaint DISCUSSION 14 Visits with only 1 visit (4.24%) 100% Successful Collection of Outcomes (2 or more scores) METHODS Retrospective data was extracted from all new episodes of care between 9/1/2016-12/15/2018 using Rehabilitation Outcomes Management System ROMS® As a part of normal operations, the Modified Low Back Disability Questionnaire (MDQ) and Numeric Pain Rating Scale (NPRS) were collected on every patient, every visit Groups were stratified by insurance plan as follows: Group 1 – University Health Plan (UHP) – Patients with this plan have all out-of-pocket expenses (deductible, copayment, co-insurance) waived when they seek care at University clinic. Sixty visits per calendar year are granted Group 2 – Non-University Health Plan (NUHP) – Patients are under the same plan as the UHP however incur cost in seeking physical therapy intervention. There is a wide variety of visits/year provided depending on the plan, however none less than 16 visits RESULTS Figure 1: Distribution of Data with primary complaint of Low Back Pain N Female Male UHP 181 107 (59.1%) 74 (40.9%) Avg Age 43.9 NUHP 135 72 (53.3%) 63 (46.7%) 33.2 Table 1: Distribution of Groups by Insurance Plan  No significant difference between groups for age(p=0.906) gender (p=0.702) or baseline MDQ (p=0.119)  Both groups demonstrated the higher the outcome score at initial visit the smaller amount of improvement.  Both groups demonstrated positive improvement over time with UHP(BU.BCS) improving better than NUHP (Figure 2)  Both groups demonstrated reduction in improvement with reported delayed time initiate PT(Figure 3)  UHP demonstrated a greater improvement by time effect (Χ2=74.582, df=48, p=0.00838)  For all individuals length of time between initiation of PT and injury onset reduces the overall improvement in outcomes.  Elimination of out-of-pocket expenses is associated with improved outcomes in pain and disability in this population sample.  Individuals with UHP come to physical therapy with lower levels of disability yet still attain greater improvement than NUHP.  Limitations – Data is retrospective and causality therefore cannot be determined. Data also represents one clinic and specific population to this region/university, may not be generalizable to a broader population CONCLUSION  In a single outpatient practice, patients with low back pain on the university health plan without out-of-pocket expense sought PT earlier and demonstrated significant improvement in patient reported outcomes and pain