Integrated physical medicine services in employer-sponsored health clinics may decrease wait times, improve clinical outcomes and lower the costs of care for patients with common musculoskeletal conditions, according to results published in the Journal of Occupational and Environmental Medicine.
Daniel J. Lord, DC, CCSP, and colleagues compared clinical and economic outcomes of physical medicine services delivered in integrated employer-sponsored clinics vs. the community.
“In our primary care model, we have the primary care physician as the quarterback but, along with the nurse, they have a physical therapist, a chiropractor, a behavioral health provider [and] health coach who surround the physician,” Lord, who is a physical medicine senior program manager at Crossover Health, told Healio.com/Orthopedics. “So, [the primary care physician] can act as a quarterback and send the patient to the right person soon and take care of a lot of musculoskeletal injuries upstream.”
To evaluate access to care, researchers calculated the lag between when patients set up appointments and their first visits. Researchers also used the Focus on therapeutic outcomes tool to collect demographic and functional status and the fear-avoidance belief questionnaire.
Results showed patients had shorter wait times for physical medicine care when accessed through the employer-sponsored clinic vs. the community, with a median time between when the patient scheduled the appointment to when it occurred of 6 days for physical therapists and chiropractors and 8 days for acupuncturists compared with 14 to 30 days in the community. Researchers noted significantly greater improvements in functional status in fear of pain avoidance among patients in employer-sponsored clinics.
“We found that not only are people getting better, but we are getting people better in far less time and with fewer visits than the community,” Lord said. “So, if you go to the community and see your physical therapist, you are going to have 10, 12, 14 visits. If you see us, we are going to do it for six to eight visits less.”
Lord added patients seen in the employer-sponsored clinics received 10-times fewer opioid prescriptions compared with in the community. Results showed patients were also highly likely to recommend integrated employer-sponsored care.
Finally, researchers found the employer-sponsored clinic led to a cost savings of $630 per patient episode overall and a savings of $472 regarding patients with back or neck pain.
“Somebody has back pain and they see us, we are saving $500 to $600 per patient and that goes along the lines of we are seeing them more efficiently and effectively, we are getting them to the right care faster, we are decreasing the amount of imaging and surgeries and injections, and decreasing the amount of pain medications in opioids,” Lord said. – by Casey Tingle
Lord DJ, et al. J Occup Environ Med. 2019;doi:10.1097/JOM.0000000000001536.
Disclosures: Lord reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.