Unrestricted Direct Access to Physical Therapist Services Is Associated with Lower Health Care Utilization and Costs in Patients with New-Onset Low Back Pain

Background: Low back pain (LBP) is one of the most prevalent conditions for which patients seek physical therapy in the United States. The American Physical Therapy Association categorizes direct access to physical therapist services into 3 levels: limited, provisional, and unrestricted. Objective: The objective of this study was to evaluate the association of level of access to physical therapist services with LBP-related health care utilization and costs. Design: This was a retrospective cohort study of patients with new-onset LBP between 2008 and 2013; data were from OptumLabs Data Warehouse. Methods: We identified 59,670 individuals who were 18 years old or older, who had new-onset LBP, and who had commercial or Medicare Advantage insurance through a private health plan. We examined 2 samples. The first was health care utilization among individuals who saw a physical therapist first in states with either unrestricted access or provisional access. The second was LBP-related costs among individuals who saw either a physical therapist or a primary care physician first. Results: Individuals who saw a physical therapist first in states with provisional access had significantly higher measures of health care utilization within 30 days, including plain imaging and frequency of physician visits, than individuals who saw a physical therapist first in states with unrestricted access. Compared with individuals who saw a primary care physician first, pooled across provisional-Access and unrestricted-Access states, those who saw a physical therapist first in provisional-Access states had 25% higher relative costs at 30 days and 32% higher relative costs at 90 days, whereas those who saw a physical therapist first in unrestricted-Access states had 13% lower costs at 30 days and 32% lower costs at 90 days. Limitations: This was a claims-based study with limited information on patient characteristics, including severity and duration of pain. Conclusions: Short-Term LBP-related health care utilization and costs were lower for individuals in unrestricted-Access states than in provisional-Access states.