There are of course legitimate arguments on both sides of the discussion on whether health care reform is working or not. Just last week I listened to a news radio station discussing how U.S. health care costs are rising faster than the consumer price index and the middle class is yet again getting squeezed with these rising costs more so than any other class in the U.S.
BCBS predicts the average cost of health care will rise 5.7% each year from 2013 until 2023. Healthcare Dive recently reported the average rate hike request across 29 state exchanges for 2017 is 20.1%. Ouch! Let’s be honest here, we are all experiencing higher health care costs and it surely is hitting most Americans in the pocketbook. Not only are premiums rising rapidly, but also since 2004 Americans have increased their spending on high deductibles by 256% and coinsurance by 107%. 
The rise in health care costs is complex and multi-faceted no-doubt. I know of no other industry where the cost of a service provided is so complex. More often than not we find most consumers don’t understand their own health care plan because it’s too complicated and full of legal jargon. There is also no common standard language or pricing for services across markets. If we truly mean business about managing the rising costs of health care, we need to equip the average health care consumer with easy-to-access information on how to become a savvy shopper.
 A Study of Cost Variation for Knee and Hip Replacement Surgeries in the U.S., The Health of America Report January 21, 2015
 Costs Paid by Workers Increasing Faster than Payments by Health Plans, kff.org 2016
The Cost of Healthcare
We are in a world today where immediate gratification is an expectation. In regards to health care decisions, most often this leads to unnecessary “aggressive” care vs conservative care which means we are seeing overuse of prescription drugs as well as needless imaging (MRIs, X-Rays, etc.), injections, and surgeries. The Medical Expenditures Panel Survey (MEPS) described in their recent research that use of prescription drugs has increased by 167% from 1998 to 2011. In addition, the average cost per person for prescription drugs rose from $665 to $1,778.
This should be a wake-up call to all Americans, we need to take control of our own healthcare decisions to ensure we are managing our care and costs. Below is an average of what we spend in the United States on various medical categories.
What is even a more staggering statistic in the U.S. is “the average cost for chronic pain is as high as $635 billion a year, which is more than the yearly cost for cancer, heart disease, and diabetes combined” (The Journal of Pain, 2012).
What most data includes is just the direct medical costs. Too often the indirect costs are not accounted for. Indirect costs include pain and suffering from recovery, the inability to work or perform functional activities while recovering, the addiction that may occur in some from pain medication use, and/or the emotional toll it takes on someone to go through such aggressive treatments.
See here is a dirty little secret that most Americans don’t know, not every health care provider/organization is paid the same. That’s right, the services you receive may be more or less expensive depending on where you choose to go for your care. There are of course various reasons why the industry does this and there is certainly an argument to be made on why this is. My point is it is so important to be a savvy shopper. I am not advocating for every American to go to the lowest cost provider, but what I am advocating is for health care consumers to shop around and based on their homework of assessing costs and outcomes, make an informed decision.
For argument sake, let’s take a look at the second leading expense in health care costs, Joint and Back Pain/Disorders. By now most of us know the general details of Prince’s death. For years, he experienced musculoskeletal pain. We don’t know all of the medical care Prince received, but we do know that Prince had a total hip replacement back in 2010 and ever since that surgery his pain continued and so did his use and abuse of prescription drugs.
The sad consequence to Prince’s story is not the tragedy most face; however, too often surgery and pain killers don’t fix the problem. If you ever get a chance, read the book Surgery, The Ultimate Placebo: A surgeon cuts through the evidence by Ian Harris. He states, “For many complaints and conditions, the benefits from surgery are lower, and the risks higher, than you or your surgeon think.”
He certainly is not saying surgeons are performing surgeries in bad faith, but he does argue “that the evidence for the success for many common operations, including knee arthroscopies, back fusion or cardiac stenting, become current accepted practice without a full examination of the evidence.”
So the question I ask is when we have a choice, a non-emergency, why are payers and medical providers not looking to direct the consumer with a conservative approach to care first? Too often we hear stories of client’s who had surgery because they have arthritis or degenerative disc disease. Studies show a majority of middle-aged Americans have arthritis or DJD, yet never need aggressive treatments like surgery or prescription drugs.
So again I say, do your homework and look at all options on the table before you decide to take a more aggressive approach to your care.
Studies are showing physical therapy (PT) for musculoskeletal care (joint, muscle, soft tissue, etc.) can often prevent or at least prolong the need for such aggressive treatments. Did you know in our own military a soldier who has a musculoskeletal injury is seen by a PT first? Why is that? Well, all PTs are trained in diagnosing and treating such injuries and PTs are a much more cost-effective, and highly qualified, option to care.
Recent data by PT Benchmark reported the average charge for a typical new case in PT is $2,186. The average cost for PT in the Midwest is $1,118. Now, let’s compare that to some recent data from BCBS for what the average cost of a total knee and hip replacement costs in our state, MN.
Source: Analysis of Blue Health Intelligence ®(BHI®) data
Why is this so important? Well, new research shows surgery doesn’t always get the results one thinks and hopes for. In 2013, Thomas Jefferson University Hospital found “people who opt for surgery for the treatment of degenerative disc disease did not experience greater outcomes in pain and disability as those who opted for physical therapy”.
You Have a Choice
Okay, so I think you get my point, do your homework and look for conservative treatments to musculoskeletal care. Making informed decisions is critical in helping reduce not only the total cost of care but the costs (direct and indirect) you will spend as well. The quick fixes through medications, or some think surgical interventions, are not always the right decision in the long run.
Most states now have direct access to physical therapy. This means you can see a PT first for your aches, pains, and dysfunctions. If you feel a visit with a physician is in your best interest before seeing a PT, then I highly recommend you see your primary care physician before you see a specialist. Not only is it your choice in which provider you seek care from, but it is also important to know not every provider is the same in cost or outcome. Your PT and/or primary care physician can work with you on establishing the best plan for you.
Just like any other health care provider, PT is no exception to the rule in saying that not every PT is the same. More often than not, a PT in private practice (not owned by a physician) will give you better outcomes at a lower cost.
A recent study completed through the scientific journal of Health Service Research found “patients who undergo total knee replacement (TKR) surgery and are referred to a physical therapist (PT) not affiliated with their surgeon’s practice have fewer visits and more individualized, one-on-one care. Conversely, the research showed that those who received physical therapy services from a clinic owned by their physician had twice as many visits and were provided a less-intensive approach”.
“When there is referral-for-profit, and from this data as related
to group therapy and an extended number of visits, it stands to
reason there is an increased risk that the patient’s individual needs
are of secondary importance to revenue. This has long been the
concern here at the American Physical Therapy Association (APTA)
and it is why we have fought so hard, alongside our partners in the
AIM Coalition, against physician-owned physical therapy services
(POPTS),” said APTA President Sharon Dunn, PT, Ph.D., OCS. “This study
provides further evidence that when the bottom line takes precedence
in health care, the patient loses. A patient’s welfare and recovery should
always be the primary focus of treatment.”
Although I would truly like to say every PT is the same no matter whom you see, it is unfortunate that the research shows otherwise. So again I deplore you when seeking a provider in PT you do your homework. It is okay to ask if the PT is owned by your physician, it is okay to ask what the cost will be, it is okay to ask about the outcomes of the PT and the practice. Do your homework to get the best possible results in your care at the best cost.
If you want to learn more about physical therapy and what a PT can do for you, please visit #GetPT1st, www.MoveForwardPT.com or follow Move Forward PT on Twitter and Facebook. You can also reach out to us for a free phone consultation to learn further about what OSI can do for you.
– Jody Ruppert, CEO at OSI Physical Therapy