Financial impact associated with implementation of the low back pain clinical practice guideline in outpatient physical therapist practice at a large academic medical center.
Heidi Kosakowski, Shari Rone-Adams, William G Boissonnault and 4 others
PMID 36567617WHAT IT FOUND
Implementing a low back pain guideline in outpatient physical therapy was associated with lower direct and downstream medical costs, including reduced spending on imaging, pharmacy, and surgery.
Total costs did not significantly decrease, and the number of physical therapy visits remained unchanged.
Key findings
01Downstream medical costs were significantly lower after guideline implementation (mean $4,636 vs. $15,502), driven by reductions in imaging, pharmacy, surgery, and other services.
02Direct physical therapy service costs were significantly lower post-implementation (mean $2,863 vs. $3,459), despite no significant change in the number of physical therapy visits.
03Total combined costs (prior, concurrent, downstream, and direct) were not statistically significantly different between the pre- and post-implementation periods.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used a retrospective design with non-randomized groups, meaning differences in patient characteristics (such as age) or unmeasured factors could influence the cost outcomes. Adherence to the clinical practice guideline was not directly measured; the authors assumed higher adherence post-implementation based on the educational activities. The analysis was limited to a six-month window and did not capture long-term costs or non-direct costs like patient travel or time off work. Multiple comparisons were not corrected for, increasing the risk of finding statistical significance by chance. The large standard deviation in pre-implementation downstream costs suggests high variability in charges, which may affect the precision of the mean estimates.
Declared interests
The authors report no relevant competing interests to declare.
The easy way to misread this
Do not interpret the reduction in specific downstream costs as a decrease in total healthcare spending for these patients. The study found that total combined costs were not statistically significantly lower after guideline implementation, meaning the savings in some areas may have been offset by costs in others.