By Erick Alvarez, PT
PT Medical Director
Earlier this year, the Journal of Orthopaedic and Sports Physical Therapy began releasing a five-part series of editorials entitled “Overcoming Overuse” in musculoskeletal healthcare. After reading the first three parts, I am anxiously awaiting the last two due out in 2021.
Overuse of healthcare is defined as “the use of services that have no net benefit or cause harm, including overlapping concepts of low-value care and overtreatment.” Currently, there is an enormous amount of overuse, estimated to be as high as 30% of total healthcare spending. One in four physical therapists provide treatments for musculoskeletal conditions that guidelines recommend against and nearly half provide treatments that have not been well researched.
The Choosing Wisely campaign aims to reduce overuse by engaging professions to publish their own do-not-do list of tests and treatments. Many professional medical bodies provide recommendations based on their type of practice. The APTA does provide recommendations for patients in The Choosing Wisely campaign which involves avoiding treatments that are not helpful. They include passive heat treatment, improper strength training for older adults, bedrest for blood clots, CPM machine after total knee replacement, and whirlpool for wound care. Unfortunately, the campaign lacks recommendations for PT clinicians which would be helpful to decrease overuse in our profession. As physical therapy grows, we must continue to provide supportive evidence of superior outcomes and improving clinical practice guidelines. This will encourage patients to seek out physical therapy to decrease pharmacological use, injections, hi-tech imaging, and surgeries.
To see this through, we must educate and encourage patients to take a more active role in their care, especially those with chronic conditions. A shared decision between patient and therapist would engage patients in treatment decisions that can overcome overuse. We must encourage patients to be independent of treatment interventions that they can perform at home without supervision. We must improve on documenting why a specific treatment was delivered and provide objective data of its benefit to substantiate the appropriateness of care. This would help measure the patient’s progress toward goals, or if physical therapy treatments are no longer useful or needed. If physical therapists are movement specialists and corrective exercises do not work, what is the benefit of specialized one-to-one physical therapy over a general gym program? What value are we giving to patients, and what would society think of the role of physical therapists in healthcare?
As SecureCare continues to advocate with payers on the benefits of conservative care, providers should continue to strive for better outcomes, especially in a value-based market. A medical provider needs to choose between what satisfies a patient and what is backed by evidence and concordant with practice guidelines. More healthcare may not necessarily contribute to better healthcare outcomes and when there is no value, may lead to overuse. We should consider the following:
- Are objective changes captured in each visit?
- Are the services rendered on each treatment providing optimal care?
- Are we assisting the patient to understand the necessary modifications needed to cope with their ailments instead of making them feel dependent on receiving continuous treatment?
As providers, we must be able to teach patients the gratification and self-assurance of being able to accomplish things on their own and provide the proper guidance to get them there. This balance will lead to further value in the outcomes of our care.
References:
- Overcoming Overuse: Improving Musculoskeletal Health Care. Journal of Orthopaedic & Sports Physical Therapy, Vol. 50, No. 3, March 2020.
- Overcoming Overuse Part 2: Defining and Quantifying Health Care Overuse for Musculoskeletal Conditions. Journal of Orthopaedic & Sports Physical Therapy, Vol. 50, No. 11, November 2020.
- Overcoming Overuse Part 3: Mapping the Drivers of Overuse in Musculoskeletal Health Care. Journal of Orthopaedic & Sports Physical Therapy, Vol. 50, No. 12, December 2020.
- Do the number of Visits and the Cost of Musculoskeletal care Improve Outcomes? More May Not Be Better. Journal of Orthopaedic & Sports Physical Therapy, Vol. 50, No. 12, December 2020.