In 2015, employers spent $482.5 billion on health insurance premiums. A significant portion of that spend was for musculoskeletal (MSK) care—second only to heart disease. MSK conditions affect all segments of the working population. They cause pain and discomfort for employees and create astronomical costs for employers.
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In recent weeks, we’ve seen the strain placed on the American healthcare system by COVID-19. The pandemic has exacerbated an existing problem: There’s not enough care to go around.
As frontline doctors and healthcare workers are doing everything they can to save lives and treat critically ill patients, other patients are without care entirely. Hospitals have canceled elective surgeries, patients are social distancing, clinics are temporarily closing (often due to a lack of personal protective equipment (PPE)), and physical therapists are looking for ways to help their patients.
This has made an already existing problem worse.
Inefficient Path to Specialized Care
With more than half of all U.S. adults reporting a chronic MSK condition, physical therapists, experts in MSK care, are often the last care providers consulted. For example, current healthcare pathways are not optimized for MSK care. Primary care physicians (PCPs), who are generally not MSK experts, tend to prescribe painkillers/opioids (which carry their own downstream risks of addiction), imaging (which, in many cases, is avoidable), or specialist referrals (which can lead to unnecessary surgeries).
Physical therapy (PT) is often seen as an afterthought when, in fact, there is a lot of research showing that early PT is the best first-line treatment for MSK pain.
PCPs sometimes lack comprehensive knowledge about MSK conditions, early interventions, or treatments. They can recommend unnecessary imaging or prescribe injections or addictive opioids for pain management instead of trying PT first. PCPs also frequently refer MSK patients to orthopedic specialists.
These specialists often lean toward surgery recommendations that do not resolve many MSK conditions. It’s only later in the traditional care journey do we see PCPs referring patients out to a physical therapist, the clinical provider who actually has more specialized knowledge about MSK care.
The irony, and the real concern for employees and employers alike, is that the Centers for Disease Control and Prevention (CDC) recommends exercise therapy, PT’s primary treatment, as the first treatment for MSK pain.
The Real Cost of MSK Pain
Employers must contend with controlling direct costs, which are projected to surpass $65 billion, but are also impacted by even pricier indirect costs, such as lost workdays and absenteeism. Given the ongoing trend of rising healthcare costs in the United States, it should come as no surprise that MSK costs are expected to increase an average of 7% year over year.
In other words, the circuitous—and costly—journey associated with traditional MSK care pathways is seemingly not aligned with CDC-recommended protocols. As a result, care labors forward with unnecessary, expensive, and exhausting stops to specialists who may not be as equipped as physical therapists to address the issues, costing you and your organization untold hours in lost performance and productivity.
Social Distancing Exacerbates the Problem
In response to the coronavirus crisis, physical therapists were forced to close their doors, leaving hundreds of thousands of patients without care. A typical physical therapist sees an average of 8–12 patients a day. Telehealth is the only way providers can help people manage and treat pain without putting both patients and healthcare practitioners at risk.
The American Physical Therapy Association (APTA) held a webinar a few weeks ago for physical therapists who wanted to introduce telehealth into their practices. The session was oversubscribed, and its follow-up Facebook Q&A has over 30,000 views. There are tens of thousands of physical therapists desperately searching for ways to help their patients through this time.
Work-from-Home Injuries Are Real
The truth of the matter is that when you are the owner of a body, that body sometimes breaks—sometimes in unexpected ways. Clinicians have seen an uptick in cases in which patients are having flare-ups of conditions like back pain or ankle/foot problems, partly because they aren’t wearing shoes while working from home.
Staying home all day, every day, under shelter-in-place orders seems to be a contributing factor to certain conditions. And this is on top of the anticipated back or neck pain caused by hastily put-together home workstations without proper ergonomic structure.
The Time Is Now for Employers to Open Access
As we look ahead to a future in which this pandemic is in the rearview mirror, we can use the lessons learned to drive improvements in health care. PT and telehealth should no longer be the last options but rather part of the primary healthcare path. Giving employees access to these options can result in better care and a better bottom line in healthcare spending.
| Dan Rubinstein is the CEO of Physera, a provider of high-quality, evidence-based virtual care for MSK conditions. With a nationwide network of licensed physical therapists, Physera’s program provides care navigation, MSK triage, diagnosis, and personalized guided exercise therapy through the convenience of your smartphone. |
Sources: Centers for Medicare and Medicaid Services. 2018. National Health Expenditure Tables. Table 24: Employer-Sponsored Private Health Insurance: Calendar Years 1987-2017. Office of the Actuary, National Health Statistics Group.