Paying PTs To Identify Psych Issues, Addiction

In a bit of an outlier but predictable move, United Healthcare has started waiving copays and deductibles for up to 3 physical therapy visits for patients presenting with low back pain. I think the decision has more to do with curtailing addiction than expanding access to therapy. PTs in five states will be part of the rollout (Connecticut, Florida, Georgia and North Carolina), with other states likely added in 2020 and 2021. The decision is a plus for PTs for now, but if you look more closely it almost pushes PT into a hybrid model as more so a diagnostic service than treatment provider. United, like other large insurers, has found that more patients use PT almost as their primary care provider, presumably to deal with pain and hard to fix musculoskeletal issues. But patients using PT have other conditions – possibly early onset of substance abuse, ongoing psych and mental illness, or as my own dad found in his years as a PT and athletic trainer, eating disorders masked as knee pain. The traditional 7 approved visits is likely still the norm but the 3 visit, no-copay allowance is no accident in our opinion. The insurer likely wants to motivate enrollees to use their PT to get the right diagnosis earlier, and motivate PTs to better manage care. This means PTs need to improve their ability to identify symptoms. Our study now about 5 years old illustrates that most groups have not been focused on finding out about a patient’s possible mental health issues and their impact, including addiction. Click here for that study: link. This also means that primary care providers, orthopedic practices and probably even educators and sports coaches need to make sure they have good relationships with a PT group. Cigna and Evicore are two other entities who are likely to explore similar initiatives as United given their focus on muskuloskeletal costs, and it’s possible BCBS and Anthem do as well. BCBS of Louisiana has started to offer an enhanced payment to PTs for sharing patient outcomes related data. At a minimum, the pilot program diverts somewhat from the trend of higher cost share for using specialists and often times requiring PCP referrals. UHC will email enrollees quarterly ‘as they gain access to the benefit’ but there are some rules: patients have to use in-network PTs and will need to have PT benefits remaining in their plan for that year to use this benefit.

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