Rewiring the MSK Care Pathway: A New Era in Musculoskeletal Health

In recent years, the healthcare industry has witnessed an urgent need to redesign the clinical pathway for musculoskeletal (MSK) conditions. Instead of prioritizing pathways that enhance patient outcomes and reduce healthcare costs, the musculoskeletal (MSK) space remains encumbered by inefficiencies, high costs, and suboptimal outcomes. However, these inefficiencies are not due to a lack of innovation or alternative solutions. Studies, like the report from the Health Services Research study in 2018, have demonstrated that a physical therapy-first (PT-first) approach to care can significantly improve patient outcomes and reduce costs for patients, payers, and the healthcare system as a whole. Now is the time to reevaluate and rewire current care pathways in order to optimize MSK care. 

The Case for PT-First Approach

As referenced in the Health Services Research study, there are now new care pathways for MSK patients that increase outcomes and lower costs – one such pathway is known as PT-First. In this new care model, physical and occupational therapy providers are positioned earlier in MSK care pathways to assess, treat, and manage musculoskeletal disorders. Instead of considering physical therapy only after medication and surgery, the PT-first pathway prioritizes physical therapy as the initial treatment option for patients with MSK conditions. This is increasingly important because, based on the 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates, the average wait for a primary care appointment is 26 daysand the healthcare workforce shortage is compounding delays in accessing care. Utilizing therapists as the primary care provider for musculoskeletal health improves access to care and would free up primary care appointments for other medical needs.

Research shows that early physical therapy intervention offers a cost-effective alternative to surgery and invasive procedures. Patients who receive physical therapy early have a 15% reduction in costly emergency department visits, a 28% reduction in advanced imaging services, and a 79% reduction in lumbar surgeries. Additionally, physical therapy has been shown to reduce the reliance on opioids by 89%, which can lead to substantial long-term decreases in opioid use. From a cost perspective, the Alliance for Physical Therapy and Quality Innovation found that a PT-first approach for acute conditions reduces total MSK costs by 58% and lowers surgical costs by 29%, saving employers approximately $1,266 and patients an average of $854 per case.Patients with chronic conditions also benefit, experiencing around a 31% reduction in healthcare costs. The financial impact of a PT-first approach can unlock massive savings knowing that one-in-two adults suffers from a MSK condition and 90% of employers report MSK conditions as their number one healthcare expenditure.

The Role of Technology in MSK Care

The proliferation of digital health tools coupled with tech-friendly policy advancements has made an omnichannel experience—combining in-person, virtual and digital care—a viable option that has benefits for patients and the clinical team. The benefits for patients include earlier access to care, convenience, flexibility, and improved health with lower expenses. Patient enhancements include easy online scheduling for either a virtual or in-person appointment, ability to chat or videoconference with a board-certified therapist to easily discuss progress and symptoms, and access to therapeutic home exercise videos. Benefits for therapists included enhanced relationships with patients, the ability to continue treatment and monitor progress outside of the clinic, and access to flexible options for treatment whether in the clinic, virtual, or using digital health tools. Human-led care, superpowered by technology with evidence-based treatments, drives the desired outcomes and enhances patient engagement. 

Policy and Payer Support Needed

To fully realize this new pathway, action is needed from healthcare stakeholders, including payers and policymakers. Many patients do not utilize physical therapy today primarily due to cost. It is crucial to institute co-pay caps for physical therapy that align with primary care rather than specialty providers, ensure fair reimbursement for all physical and occupational therapy providers, and implement value-based payment models that incentivize outcomes. Additionally, requiring physical therapy as a first-line intervention, when appropriate, before more costly treatments can minimize unnecessary interventions and expenses.

A Brighter Future for MSK Care

With lower costs, better patient outcomes, and increased accessibility to quality PT services, this paradigm shift is the change needed to optimize the care delivery system and improve the health of the millions of people who suffer from a musculoskeletal health condition. Unleashing the untapped potential within these redesigned MSK pathways will undoubtedly lead us toward a future where efficient, cost-effective, and compassionate healthcare is accessible to those in need.