TRICARE Thinks PT is so Valuable, They’re Covering the Whole Cost!

TRICARE, one of the nation’s largest insurers wants their members to get physical therapy for back pain. They think that treating back pain with PT is so important that they’re willing to waive the cost to their members. That’s a huge deal. When’s the last time you remember an insurance company covering the entire cost of anything? Let’s dive into back pain treatments and see why TRICARE likes PT so much.

You probably already know that back pain is a common problem. What you might not know is that the medical system isn’t very good at treating it. “Non-drug treatments like physical therapy” are the first treatment recommended for back pain. Unfortunately, many providers don’t follow this and treatments are often recommended based on opinion rather than research. This means insurance companies and patients often end up spending a lot of money for outcomes that are less than stellar.

Here’s how it usually goes: You go see your doctor with back pain. They might give you medication, recommend rest, some stretches, send you for x-rays or an MRI. Next will likely be a referral to a specialist like an orthopedic surgeon. Chances are you won’t be having surgery right away, so the specialist will either refer you to PT, or back to your PCP where you’ll end up with a PT referral. The path will look different for each person, but the end result is usually the same – multiple failed treatments, imaging you probably didn’t need and a delay of weeks or months to get to a physical therapist.

Multiple large studies have looked at the effects of early physical therapy on low back pain with impressive results. One of them was done in 2006 in Seattle by Virginia Mason Health Center. They teamed up with Aetna and Starbucks to send workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great, that Virgina Mason was losing money on treating back pain and Aetna ended up paying them more for PT treatments because Aetna was saving so much money.

Intel ran a similar program with their employees, getting people with back pain to a PT within 48 hours. Previously it took about 19 days for people to get to a PT. With the earlier access, patients completed their care in 21 days, compared with 52 days previously and costs dropped between 10 and 30%. Intel also found more satisfaction with care and a faster return to work.

The data is out there that proves physical therapy is the cheapest and most effective treatment for most people’s low back pain. It’s clear that people with back pain should start treatment with their physical therapist, but most don’t. TRICARE’s pilot program that waives copays for up to three PT visits aims to change that. If successful it will lead to lower costs for both TRICARE and their members while delivering better outcomes in less time.

Provided by: Private Practice Section, APTA