Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost

Lord, Daniel J. DC, CCSP; Wright, John R. MSc; Fung, Rebecca DPT; Lederhaus, Eric S. DPT; Taylor, Katie PhD; Watts, Sharon A. MA; Hagg, Heather K. PhD; Bravata, Dena M. MD, MS

Journal of Occupational and Environmental Medicine: May 2019, Volume 61, Issue 5, pp. 382-390

Objective: The aim of the study was to evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics.

Methods: Retrospective cohort analysis comparing clinical and economic outcomes of physical medicine services delivered in employer-sponsored clinics within the community.

Results: Integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to seven days (two to four times faster than in the community). Patients receiving care in employer-sponsored clinics experienced marked improvements in fear of pain avoidance behaviors (P < 0.00001) and functional status (P < 0.01) in eight fewer visits than in the community (P < 0.0001), resulting in $472 to $630 savings/patient episode. Non-cancer patients received 1/10 the opioid prescriptions in employer-sponsored clinics compared with the community (2.8% vs. 20%). Patients were highly likely to recommend integrated employer-sponsored care (Net Promoter Score = 84.7).

Conclusions: Findings suggest robust clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics.

Musculoskeletal complaints are among the most common reasons for outpatient visits among adults in the United States.1 At any time, approximately 1/3 of all US adults are affected by joint pain, swelling, or limitation of movement and about 2/3 of adults experience back pain at some point in their lives.2 The direct and indirect costs associated with low back pain are estimated between $96 billion and $238 billion annually,3,4 and expenditures for back pain are rising more quickly than overall health expenditures.5–7 Given that musculoskeletal complaints represent the second largest cause of short-term or temporary work disability, employers bear a disproportionate share of these costs, including approximately 290 million lost workdays annually.4

Employees with musculoskeletal complaints suffer from delays in obtaining physical medicine for their pain and overutilization of high-cost imaging procedures, orthopedic and neurosurgical specialist visits, and prescription pain medications including opioids.8–11 In contrast, a strategy of early access to physical therapy in employee populations has been associated with a 36% improvement in patient outcomes, 52% less imaging, 56% fewer spinal injections, 59% less lumbar surgeries, and 62% less opioid use.12

Employers are increasingly seeking solutions that provide their employees with rapid access to high-quality musculoskeletal care.13 A potential for serving this need is on-site physical medicine care. Although approximately 30% of employers with 5000 or more employees have on-site clinics,14 less than 50% of on-site clinics have integrated physical therapy,15 and very few have comprehensive physical medicine services that include physical therapy, chiropractic, and acupuncture care with on-site primary care.

The purpose of this study is to evaluate the effects of employer-sponsored clinics that integrate a comprehensive physical medicine offering with primary care on key clinical and economic outcomes. Specifically, we hypothesized that employees with musculoskeletal pain cared for in an integrated clinic would have (1) increased access to physical medicine services, (2) equivalent or greater improvements in pain and functional status outcomes, (3) decreased opioid use, (4) improved patient experience, and (5) decreased total costs of care compared with similar patients cared for in the community.

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