Financial impact associated with implementation of the low back pain clinical practice guideline in outpatient physical therapist practice at a large academic medical center

ABSTRACT

Introduction

Low back pain (LBP) is the top health condition requiring rehabilitation in the United States. The financial burden of managing LBP is also amongst the highest in the United States. Clinical practice guidelines (CPGs) provide management recommendations and have the potential to lower health costs. Limited evidence exists on the impact of CPG implementation on downstream medical costs.

Objective

To examine the impact of CPG implementation in physical therapist (PT) practice on direct and downstream costs for patients with LBP.

Methods

A retrospective observational study examined billing data from 270 patients with LBP who were treated at multiple sites within one large academic medical center by PTs who participated in a multifaceted CPG implementation program. Costs were analyzed for direct PT services, downstream medical services, and PT utilization from September 2017 to March 2018 (pre-implementation group) and compared with costs from June 2018 to December 2018 (post-implementation group).

Results

Direct PT costs were significantly lower post-implementation than pre-implementation mean: $2,863 USD (SD: $1,968) vs. $3,459 USD (SD: $2,838), p = .05, 95% CI [11, 1182]. All downstream costs were lower post-implementation with statistically significant lower costs found in downstream imaging: p = .04, 95% CI [32, 1,905]; pharmacy: p = .03, 95% CI [70, 1,217]; surgery: p = .03, 95% CI [446, 9,152], and “other”: p = .02, 95% CI [627, 7,920].

Conclusion

Implementing the LBP CPG in outpatient PT practice can have a positive impact on lowering downstream costs and the potential to increase the value of PT services.

KEYWORDS:

• Low back pain
• practice guideline
• cost and cost analysis

Acknowledgments

The authors would like to acknowledge Paul Tadak, Lucas VanEtten, and the members of the medical center “Low Back Pain Team.” The project described was supported by Award Number UL1TR002733 from the National Center for Advancing Translational Sciences.

Disclosure statement

The authors report that there are no relevant competing interests to declare.

Additional information

Funding

This work was supported by the National Center for Advancing Translational Sciences [UL1TR002733].