George Washington School of Medicine and Health Sciences faculty in partnership with the University of Washington, Department of Family Medicine co-authored a policy brief that focuses on whether unrestricted direct access to physical therapy reduces utilization and health spending. The brief was published by the Health Care Cost Institute (HCCI), a non-partisan, non-profit organization with a public-interest mission.
Kenneth Harwood, Ph.D., PT, director of the Program in Health Care Quality, director for research for the Program in Physical Therapy, associate professor of Clinical Research and Leadership, and associate professor of Physical Therapy and Health Care Sciences, and Jesse Pines, M.D., M.B.A., director of the Office for Clinical Practice Innovation and professor of Emergency Medicine and Health Policy and Management collaborated with University of Washington Center for Health Workforce Studies’ faculty and staff including former GW faculty member and Principal Investigator Bianca Frogner, Ph.D., Holly Andrilla, M.S. and Malaika Schwartz, M.P.H.
HCCI’s overarching goal is to provide complete, accurate, unbiased information about health care utilization and costs to better understand the U.S. health care system. The brief was released in late February 2016 under HCCI’s State Health Policy Grant Program, which supported six independent research projects analyzing how states are implementing the Affordable Care Act and other reforms to improve their health care systems.
The study conducted by Frogner, Harwood, Pines, Andrilla and Schwartz entitled, “Does Unrestricted Direct Access to Physical Therapy Reduce Utilization and Health Spending?” analyzed the relationship between how physical therapy (PT) services are accessed — through direct access or where a physician referral is required — and health spending by using private health insurance claims data provided by HCCI. The team examined health care utilization and cost data of patients with low back pain in the northwestern U.S., who had varying levels of direct access to PT services.
“This study is important because health care costs are continuing to escalate in the United States without a thorough understanding of where the money is going and what is optimal care. This is especially important for low back pain which is estimated to cost the United States up to $90 billion in direct costs a year,” said Harwood. “Our end goal is to find the best treatments for patients in the right time frame so that patients have optimal outcomes at the lowest cost for all.”
The study found that seeing a PT as the first point of care, compared to seeing a PT at a later point in time or not seeing a PT, reduces the utilization of potentially costly services. Of particular interest was the significant decrease in opioid prescriptions, emergency department visits, and imaging for those patients who saw a PT first, showing that access to PT could have an impact on health care costs, including out-of-pocket costs across all settings.
The researchers found that states should consider reviewing their laws that restrict direct access to PT services.
