New Research to Share with Your Physician Referral Sources

Today’s guest article comes from Heather Chavin with CareConnections Outcomes Platform.

This recent article in Physical Therapy is a gold mine for both physician and direct to consumer marketing.

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs1 https://academic.oup.com/ptj/article/98/5/336/4925488

Researchers reviewed the cases of almost 47,000 patients with acute lower back pain (LBP) between 2009-2013 (18-65 with commercial insurance in NY). They looked at healthcare utilization and cost within a year for each patient. They found that utilization and cost were lowest in those that didn’t receive physical therapy (PT) at all, but noted that a quarter of that group had higher costs. The authors recommended further research to identify the characteristics of this population so that a more appropriate referral can be made.

For those that did receive PT, the longer the wait for the referral, the higher the overall cost. Referrals within three days had the lowest cost. The odds ratios aren’t the most compelling but they are significant.

Of particular relevance is that the group that did not receive PT also had higher opioid prescription rates than the group that received PT within three days. Patients receiving PT within three days were not only less likely to be prescribed opioids than all the other groups, but they also had lower costs associated with pain medication and advanced imaging costs (including as compared to the group not receiving PT).

When a patient accesses physical therapy services for acute LBP within three days of onset, they’re less likely to be prescribed opioids and are more likely to incur fewer expenses related to medication and advanced imaging.

The study also looks at who is doing the referring. Overall, it’s primary care physicians (PCPs) that were most often referring patients to PT. HOWEVER! It was NOT PCPs that were most often referring within the three-day window. That gold star went to the physical medicine and rehabilitation physicians.

How to use the research in your conversations with referral sources and consumers

What does it all mean? It means you have more ammunition when talking to physicians about immediate referrals to PT and how PT can be a better prescription than opioids!

If you have a platform to speak to consumers directly, you can talk about how people with acute LBP who access care within three days are less likely to need opioids and their care costs less. As consumers must foot more of their healthcare bill, they will be tuning into this kind of message more and more.

If you’re going to speak to physicians, start with your physical medicine and rehabilitation physicians. It’s easier to sell more to someone who is already buying. Bring the article to illustrate your point about the three-day timeline to get those referrals to your door faster. Bring your administrative staff to the meeting so you can figure out a process to get those patients in fast. There’s no point in convincing a doc to send someone right over and then not be able to get them on your schedule for two weeks.

For PTs uncomfortable talking to physicians, here’s a suggested play-by-play:

Contact the office of the physician to discuss a current patient. If you’re not sure who to start with, pull your CareConnections Overview Report: Referral Source by Acuity. [LINK]
Identify the physicians whose patients are reporting onset at 16 days or higher. Now see if you are seeing any of their patients currently for LBP.
Contact the physician for a time to discuss their patient – make sure there is something to genuinely discuss about the patient or perhaps a protocol. Go in person! Don’t cop out with a phone call if you can help it!
Bring your patient’s Registration Summary [LINK] for an informed discussion. Bring a copy of the article.
As part of your discussion, talk about the protocol for acute LBP and share the article. Say, “For those patients that are appropriate for physical therapy, the cost and opioid usage rates are lower if you get them to me within that three-day window. I’d love to connect our office staff to look at setting up a process for getting these types of patients in fast.”
Make SURE to follow up immediately. Make sure that office staff connection happens. Make sure you are able to get patients in and of course, make sure to follow up with a thank you and comments about how well it’s going. Maybe a few more Registration Summaries to illustrate your successes!

We know from a recent study2 https://link.springer.com/article/10.1007%2Fs11606-018-4426-6 in the Journal of General Internal Medicine that referrals from physicians dropped 50% between 2003 and 2014 in favor of referrals to specialist physicians. Although there is a push to increase marketing directly to the consumer (and rightly so), we can never discount the value of the physician relationships. The future of healthcare is effective interdisciplinary teams. Here’s your opportunity to be MVP.

1Liu, Xinliang & Hanney, William & Masaracchio, Michael & Kolber, Morey & Zhao, Mei & Spaulding, Aaron & H Gabriel, Meghan. (2018). Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Physical therapy. 98. 336-347. 10.1093/ptj/pzy023.

2 Freburger, J.K., Khoja, S. & Carey, T.S. J GEN INTERN MED (2018) 33: 801. https://doi.org/10.1007/s11606-018-4426-6