According to a new study that appears in the October 1, 2014 issue of the Journal of Bone & Joint Surgery (JBJS), joint replacement patients who undergo preoperative physical therapy (PT) are saving “the system” money. As indicated in the October 7, 2014 news release, the researchers demonstrated that preop PT can reduce the need for postoperative care by nearly 30%, saving an average of $1, 215 per patient in skilled nursing facility, home health agency or other postoperative care.
Data was obtained for 4, 733 total hip replacement (THR) and total knee replacement (TKR) patients (from Medicare claims). “Approximately 77% of patients utilized care services following surgery. Patients receiving preoperative physical therapy showed a 29% reduction in postoperative care use. In addition, 54.2% of the preoperative physical therapy group required postoperative care services, compared to 79.7% of the patients who did not have preoperative therapy.”
“The decline in postoperative care services resulted in an adjusted cost reduction of $1, 215 per patient, due largely to lower costs for skilled nursing facility and home health agency care. Preoperative physical therapy cost an average of $100 per patient, and was generally limited to one or two sessions.”
“This study demonstrated an important opportunity to pre-empt postoperative outcome variances by implementing preoperative physical therapy along with management of comorbidities before and during surgery, ” said orthopedic surgeon Ray Wasielewski, M.D., co-author of the study, in the October 7, 2014 news release. Dr. Wasielewski is a physician with OhioHealth in Columbus, Ohio.
Richard Snow, D.O., M.P.H., also with OhioHealth and was a co-author on the study. He told OTW, “We were surprised to find the magnitude of the effect that pre-operative physical therapy (POPT) had on the post-acute care, especially considering the number of visits. After thoughtful consideration, the authors agreed that the process of POPT is probably associated with other patient centered processes that providers are using that cumulatively have the effect on post-acute care utilization patterns.”
Asked about barriers to implementing preoperative physical therapy, Dr. Snow commented to OTW, “The major challenges to implementing this type of program are similar to challenges we all face with an increasing demand for delivery of value-based care. First is reducing the fragmentation that comes from the siloed approach to payment. Reengineering care to provide patient centered care across the continuum needs to be facilitated by reengineered payment allowing that care. Second is building the competencies necessary to do adequate pre-operative assessment, both physical and environmental, and building a joint expectation with the patient regarding post-acute recovery.”
