Relation Between Payer Source and Functional Outcomes, Visits, and Treatment Duration in US Patients with Lumbar Dysfunction

Abstract
Background: The differences in the utilization of healthcare services and resultant charges for symptoms like back pain has necessitated those payers of healthcare services in the United States (US) make efficient decisions relative to resource utilization. Studies involving both public and private payers of healthcare services in the United States have shown that payer source makes a difference in utilization of resources and patient outcomes. With the current focus on efficient and effective treatment, further research is needed on the relationship between payer source and patient outcomes. Purpose: To examine the association between payer source and number of visits, duration of treatment, and discharge functional status (FS) for patients with lumbar dysfunction who received physical therapy (PT) services. Methods: This retrospective study used secondary analyses of the Focus On Therapeutic Outcomes, Inc. (Knoxville, TN, USA), database that contained FS measures, number of visits, and treatment duration. Data were analyzed from 16,977 patients who received PT for lumbar dysfunction. Patient self-report surveys were used to estimate risk-adjusted FS at discharge. Therapists reported number of treatment visits and calendar days of treatment duration. Results: Patients receiving benefits from indemnity insurance and managed care plans (private funding) reported the highest risk-adjusted discharge FS measures. Patients receiving benefits from Medicaid (public funding) reported the lowest discharge FS measures and least number of visits. Patients receiving benefits from Workers’ Compensation and patients involved in litigation had the longest treatment duration and highest number of visits. Conclusion: Results suggest that patients receiving benefits from different payers of healthcare services may differ in utilization of resources and outcomes. Further study is needed across a variety of diagnoses and payer sources to investigate the effect of payer source on utilization of physical therapy services and patient outcomes.