October 20, 2020 Using Physical Therapy First to Treat Employee MSK Pain

Employees who go to PT first receive faster and more sustainable relief for musculoskeletal pain while employers reap greater cost-savings.

By Brett Windsor, PT, PhD, MPA, Senior Vice President at ATI Physical Therapy

Musculoskeletal (MSK) pain is a common problem for employees and employers, especially for those working in the manufacturing, shipping and retail industries. The repetitive and tedious movements necessary for these lines of work can make employees prone to chronic MSK complications, including spine, shoulder and knee pain, and can oftentimes lead to missed days at work. According to estimates by the National Safety Council (NSC) based on analysis of data from the Bureau of Labor Statistics (BLS), the total cost of work injuries in 2018 was $170.8 billion, including wage and productivity losses of $52.4 billion, medical expenses of $35.0 billion and administrative expenses of $57.6 billion.

Additionally, the BLS Survey of Occupational Injuries and Illnesses for 2011-2018 reported 900,380 nonfatal, work-related injuries and illnesses that caused days away from work in 2018 alone. Of this figure, 118,580 were reported by private ownership establishments in the manufacturing industry, with 34,270 categorized as sprains, strains or tears; 15,950 categorized as soreness, pain; and 13,210 categorized as fractures (NSC).

Fortunately, there’s an effective solution that can help manage these areas of pain: physical therapy (PT). Physical therapists are specially trained through three years of a doctoral education program to understand human movement. They’re trained on how to use skills, knowledge and expertise to optimize movement, promote health and wellness, and to mitigate the progression of MSK conditions. PTs take a holistic approach to MSK pain, applying best practices in rehabilitation and strength training proven to improve function and prevent additional disability.

Physical therapists apply best practices in rehabilitation and strength training to improve function and prevent additional disability.

Going to PT before trying other traditional methods for treating pain and injuries is proven to be faster, healthier and more cost-effective. Studies reveal that PT decreases costs of other types of pain management treatments, including 89% lower probability of needing an opioid prescription, 28% lower probability of having imaging services and 15% lower probability of a costly ER visit. Plus, these methods commonly lead to PT at the end of the treatment journey regardless (e.g., emergency room to orthopedic specialist; orthopedic specialist to surgery; and finally, surgery to PT). In fact, 70% of patients that utilize PT first for spine, shoulder or knee pain today are successfully treated without the use of imaging, prescription medication or physician visits, ultimately saving thousands of dollars in deductibles and insurance charges (JOSPT, 2017).

There is also a myriad of employer advantages when offering options for employees to visit PT first, specifically through employer-sponsored health insurance and benefits. Today, improving outcomes and reducing costs are even more relevant with the cost of employer-provided health care coverage for families reaching $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their family coverage (2020 Kaiser Family Foundation’s annual poll of employers). With employers bearing a majority of the cost per year and employees responsible for the remaining balance, going to PT first provides a viable and attractive cost-saving option for all parties.

Numerous organizations within the PT industry have committed themselves to disrupting MSK care by flipping PT from ”reactive care” delivered after traditional medical care to a PT-first model. For instance, ATI Physical Therapy built upon its best therapy practices to create “ATIFirst,” an approach rooted in the idea that when PT management occurs earlier for patients with an MSK problem, they improve faster and with lower costs compared to patients who go to an emergency room, orthopedic specialist or undergo surgery. The ATIFirst program also allows for on-site physical therapists in work settings that could require intervention, such as warehouses, manufacturing and research-discovery locations, to tackle issues swiftly and head-on.

In October 2018, ATI implemented ATIFirst with a large Midwest trade union organization to help eliminate access barriers to care for 52,000 members through a direct access contract with a $0 co-pay. The first-year impact was stunning with over a $9.4 million (28%) reduction in associated MSK spend. This included an 8% decrease in MRI spend (>$1 million in savings), and a 68% decrease in surgical/injection spend. Simply shifting PT care away from hospital-based PT reduced the cost of PT by $2.3 million, while risk-adjusted clinical outcomes revealed patients achieved improved function, which both increased their ability to participate in work functions, but also decreased the likelihood of recurrence and additional, more expensive interventions.

Educating all parties involved about the benefits of choosing PT first is important for popularizing this treatment option and achieving widespread adoption. Though PT hasn’t always been the first solution considered when confronting high health care costs, its proven effectiveness and cost-saving benefits make it a highly attractive treatment option for MSK-related issues. Healthcare expenditures for MSK pain can make up a hefty bill for employers even when the outcomes are less effective for employees. Going to physical therapy first yields more cost-efficient results for employers, while at the same time leading to faster and more sustainable treatment for workers experiencing pain.

Brett Windsor

Brett Windsor, PT, PhD, MPA, is a Senior Vice President with ATI Physical Therapy, a nationally recognized rehabilitation provider specializing in research-based physical therapy, workers’ compensation rehab, employer worksite solutions, sports medicine, home health and a variety of specialty therapies. www.atipt.com

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