The Value of Well-care

TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical
therapist for low back pain. They’ve said that the goal is to encourage more use of “high-value”
treatments for low back pain. Understanding what they mean by “high-value” vs “low-value”
treatment can help us see the direction healthcare payers are moving and how physical therapy
is a part of that.

TRICARE tells us in their summary of this demonstration what they mean by high and low-value
care: “Increasing the value of health care refers to improving patients’ quality of care and
outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast,
low-value care refers to interventions that: are not proven to benefit patients; may harm patients;
result in unnecessary costs; or waste health care resources.”

High-value care

High-value care leads to better outcomes, is easy to access and is cheaper for both patients
and insurers. We already know that physical therapy fits into this category, but if we look at
other things that fall into this category, a larger theme starts to emerge. In 2017 the American
College of Physicians released guidelines for treating low back pain that have been widely
endorsed. Initial treatment recommendations include exercise, stretching, tai chi, yoga,
progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise.
These are all active treatments, where the practitioner and the patient are working together to
improve. This is “well care” or “let me help you get better.”

Low-value care

In contrast, low-value care tends to be “sick care” where the patient is a passive participant and
the practitioner is saying “let me make you better.” TRICARE puts imaging before six weeks
without red flag symptoms, surgery for non-specific low back pain, opioids as the first or second-line treatment, and bedrest in the low-value category. We would also place spinal injections in
this category for most people. They’re expensive, only offer temporary relief, usually have a long
wait before they’re available and include the risk of serious infection and damage to surrounding
soft tissues like skin, cartilage, and ligaments.
This isn’t to say that imaging, surgery, or injections are always bad. For a small percentage of
people with low back pain, they’re the right thing. But, most people should start with treatments
that have the best outcomes for the lowest cost. If those treatments tend to focus on
empowering the person in pain to actively participate in their care rather than making them
dependent on someone to “heal” them, that’s even better. Physical therapists have known this
and have been providing care that fits this model for years. TRICARE’s demonstration that
waives cost-sharing clearly shows that insurers are recognizing the value of this type of care
and that they are actively moving in this direction.

Learn more about Tricare’s initiative for Free Physical Therapy here.

Learn more about how we can help at by contacting us

• by email at atwcny@gmail.com
• or phone at (315)765-0063
• or learn more about our Physical Therapy and Wellness memberships on our website at atwcny.com

Shoulder Pain and Frozen Shoulder

Shoulder pain with a “stuck” or frozen shoulder is one of the more common shoulder conditions we see in the physical therapy world.  This condition is also known as adhesive capsulitis. It is characterized by shoulder pain and loss of motion in multiple directions, especially movements that involve rotating the lower arm outward and reaching out to the side, away from the body. The condition usually starts with shoulder pain alone and then progresses into limited movement in some motions and progresses to all motions around the shoulder joint. If allowed to worsen, this can cause severe limitation in movement with associated functional limitations. Physical Therapy is commonly prescribed to help and we see good results.

Here are three essential things you should know about the condition of Adhesive Capsulitis, aka Frozen Shoulder:

Number One:

This condition more frequent in those ages 40-65 years is more common in women than in men. It is also more common in individuals with diabetes mellitus, thyroid disease, and those who have had adhesive capsulitis in the past.

Number Two:

Adhesive capsulitis can look like other medical or orthopedic conditions, so it is important that you have an evaluation with your health care provider (physician, nurse practitioner, physical therapist, etc.). They will help you determine the best direction of care for your individual shoulder issues. Injections and/or physical therapy treatments are common, evidence-based interventions that may be recommended.

Here’s what to expect if you are referred for physical therapy:

 A comprehensive evaluation.

Based on your particular presentation and movement tolerance, the physical therapy evaluation will likely include a self-report functional measure, pain assessment, motion measurements, and functional review.

 A treatment intervention plan tailored to your needs and goals.

This may include: 1) Education/instruction in the condition, activity modifications, stretching, and other topics.  2) Treatment modalities to decrease pain, promote healing, and promote tissue extensibility. This may include therapeutic ultrasound, electrical stimulation, or other modalities.  3) Joint mobilization to reduce pain and improve motion and function. 4) Individually tailored stretching exercises to improve movement and function.

Number Three:

A frozen shoulder can be quite limiting and interfere with daily activities. Unfortunately, adhesive capsulitis is not uncommon. It is reported 2% to 5.3% of the general population is affected by this condition. The good news is that there are treatments that can help you have less pain, improve your motion, and regain your function.

Want to learn more about how we can help your shoulder pain or frozen shoulder? Call ATW at (315)765-0063 for your FREE CONSULTATION and if indicated, we can help you get started with a comprehensive physical therapy evaluation and treatment plan.  Learn more about our Physical Therapy Services for orthopedic conditions here.

References:

https://www.jospt.org/doi/full/10.2519/jospt.2013.0302

Back Pain

Back Pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and usually doesn’t require surgery either. Why is it so expensive?

The first reason is that it’s so common. The second reason is that our current system isn’t very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls “high value” treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they’re likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That’s about half the rate of attendance found in the lowest co-pay group.

The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.

Do you or someone you love have back pain? We can help. Call (315)765-0063 today!