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.
