ARTICLE
Musculoskeletal complaints are among the most common reasons for outpatient visits among adults in the United States. The direct and indirect costs associated with low back pain are estimated between $96 billion and $238 billion annually, and expenditures for back pain are rising more quickly than overall health expenditures. 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. 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. In contrast, a strategy of early access to physical medicine 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. Employers are increasingly seeking solutions that provide their employees with rapid access to high-quality musculoskeletal care. A potential for serving this need is onsite physical medicine care. While approximately 30% of employers with 5000 or more employees have onsite clinics, very few have comprehensive physical medicine services that include physical therapy, chiropractic, and acupuncture care with onsite primary care. This study was performed to evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics. It found that integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to 7 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 and functional status in eight fewer visits than in the community, resulting in $472 to $630 savings/patient episode. Noncancer patients received 1/10th the opioid prescriptions in employer-sponsored clinics compared with the community. Patients were highly likely to recommend integrated employer-sponsored care. The study concluded that findings suggest robust clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics. Soucre:https://journals.lww.com/joem/Fulltext/2019/05000/Integrated_Physical_Medicine_at_Employer_Sponsored.3.aspx?fbclid=IwAR2lmiWQ3CahTKiFC94sVxmbKI4_K25ksOOxnznk01METyEsGvGT18v4WaQ