Episode of Care Characteristics Following Implementation of a No Copay Physical Therapy Program for Musculoskeletal Conditions.

Patients chose their care pathway, so people who used no copay physical therapy may have been different from those who did not, and this could explain the service use patterns. The study was descriptive and not analytic, so it cannot attribute differences to the absence of a copay. No patient-reported outcomes were available, so the paper cannot show whether care was better, worse, or similar for pain, disability, or quality of life. Claims data required assumptions about diagnoses, procedures, and episode boundaries, and some episodes may have grouped different conditions in the same body region. Prescription data were missing, so medically focused episodes may have been shorter than they really were. The sample came from one self-insured employer, with beneficiaries mainly in Illinois and Indiana, so it may not generalise to other populations or health systems. The observation period included the COVID-19 pandemic, which may have affected later care decisions. The no copay benefit was not a required physical therapy first pathway, so the analysis cannot separate the effect of copay removal from direct access or preferred provider features.

ATI Holdings, LLC, a physical therapy provider, funded the work, provided all data and input on the research question and study design, and reviewed the manuscript for accuracy of the program description; Duke investigators had full scientific freedom to publish.

Do not read the lower imaging and physician service rates as proof that removing physical therapy copays caused those reductions. Patients chose their care, the study was descriptive, and it did not measure pain, function, or quality of life.