Employers that offer onsite physical medicine have seen improved quality of care, reduced costs and decreases in opioid use. Results from a new study published this month in the Journal of Occupational and Environmental Medicine found that patients using onsite clinics experienced much shorter wait times to access services and required significantly fewer visits than patients receiving care in the community, resulting in average savings of $630 per patient episode.
Musculoskeletal medicine is typically a top expenditure for employer-sponsored health plans. Approximately half of the adult population is affected by a musculoskeletal condition. The annual direct and indirect cost is $847 billion -- the equivalent of 5.7% of GDP! And, despite solid evidence that over 50% of lumbar spine surgeries are found to not be medically necessary, healthcare systems and health plans have not made much progress in curbing unnecessary procedures.
A growing number of employers are addressing this large expenditure by staffing physical therapists in their on-site clinics. In a 2018 survey of 121 employer-sponsored clinics, we found that 28% had physical therapists on staff. This is up sharply from 2015, when only 17% of the clinics surveyed had physical therapists on staff. While we believe onsite physical therapy is beneficial, the JOEM study supports staffing a musculoskeletal practice team that is equipped to assess patients with musculoskeletal conditions. These teams follow agreed-upon, established treatment protocols that have been shown to be effective. A protocol shown to improve outcomes includes:
- Rapid access to care
- An evaluation that includes an assessment of the individual’s reaction to their condition (the fear-avoidance assessment)
- Following an agreed-upon treatment protocol
- Avoiding imaging, opioids and passive treatments such as injections
- Emphasizing active treatment and education
- Including an embedded data program to track functional improvement throughout treatment
We’re big proponents of offering employees the opportunity to complete a therapy treatment protocol at work rather than off-site, where the logistics can very difficult. Being able to offer the broader services of a musculoskeletal practice team to promptly help people with pain and use the conservative approaches outlined in the study can be clinically very effective and save a great deal of money by eliminating waste.