Managed Care - June 2008 - (Page 47)

Health Plan Joins With Physical Therapy Facility to Manage Back and Neck Pain Capital Health Plan achieved a 79% improvement in pain scores and a 54% improvement in function scores for its members Charles M. Tomlinson, MD, vice president for medical affairs, John D. Archbold Memorial Hospital; Chad Gray, PT, orthopedic and sports physical therapy; Tom Kane, PT, orthopedic and sports physical therapy ABSTRACT Twenty-five billion dollars is spent each year on the medical care of back pain, and $50 billion is lost in productivity. Primary care physicians might have difficulty providing thorough counseling and treatment to their patients about the condition. In 2006, Capital Health Plan (CHP) partnered with Orthopedic and Sports Physical Therapy, which employed the mechanical diagnosis and therapy (MDT) technique. After undergoing this technique, members experienced a 79% improvement in pain scores and a 54% improvement in function scores, compared to when they started treatment. BACKGROUND Neck and back pain are extremely common in the general population. More than 50% of Americans will have back pain every year. Twentyfive billion dollars is spent each year Disclosures Charles M. Tomlinson, MD, served as vice president at Capital Health Plan from 2000 to 2008. Chad Gray and Tom Kane are physical therapists certified in mechanical diagnosis and treatment techniques by the McKenzie Institute. Author correspondence Charles M. Tomlinson, MD Vice President for Medical Affairs John D. Archbold Memorial Hospital P. O. Box 1018 Thomasville, Ga. E-mail: ctomlinson@archbold.org Phone: (229) 228-2741 Fax: (229) 228-2768 on the medical care of back pain and $50 billion is lost in productivity each and every year.1 Our patients want quick answers and quick fixes, yet this is one malady where patience is critical. Unfortunately, patients with neck and back pain typically demand X-rays and other high-technology imaging scans, such as magnetic resonance imaging (MRI), and few health care providers are willing to explain why these are most likely unnecessary during the acute phase of back pain management. Radiology costs have skyrocketed over the past decade and Capital Health Plan (CHP) has been no exception. Once the MRI is performed, the practitioner will refer the patient for pain management, where epidural steroid injections are likely. Pain management practices have literally multiplied in our community in recent years. Our small town now has four full-time pain management specialists. Five years ago there was only one. Yet the population has not changed significantly. In the United States, nearly $50 million was spent in 1999 for epidural steroid injections, and in one study of 300 patients, no improvement could be found at 24 hours, 3–6 months, or one year after treatment.2 The annual trend for total pain management procedures in 2005 and 2006 for our health plan was 46% and 19%, respectively. There are a myriad of techniques used by pain management specialists, orthopedic surgeons, and neurosurgeons. We have seen a rise in requests for IDET (intradiscal electrothermal therapy to the disc annulus), disc decompression, and microdiscectomy. There is very little literature support clearly demonstrating the benefits of these procedures. Many health plans consider most investigational. SURGERY Surgical procedures of the spine are very popular in Tallahassee. Capital Health Plan (CHP), a staff-model primary care practice, has experienced surgical rates well in excess of the 90th percentile based on our NCQA Quality Compass comparison data over the past two years. The American Medical News reported that delaying surgery does not appear to cause damage. These studies were specific to the surgical treatment of spondylolisthesis, but certainly support the general knowledge that most patients with low back pain will get better over time whether they pursue medical or surgical treatment. The vast majority of these patients JUNE 2008 / MANAGED CARE 47

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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