TRICARE to Provide Free Physical Therapy for Low Back Pain
Free Physical Therapy for Low Back Pain to Be Provided by TRICARE
The Defense Department recently published a notice outlining a new demonstration that will begin January 1, 2021 and run until December 31, 2023. TRICARE beneficiaries in select states who have a documented diagnosis of low back pain will receive three free physical therapy visits. The goal of the demonstration is to determine whether waiving physical therapy cost-sharing will incentivize more beneficiaries to attend physical therapy, which may in turn reduce overall healthcare costs and improve patient outcomes.
Physical Therapy and Low Back Pain
Physical therapy is generally recommended as a first line of treatment for those with low back pain episodes lasting longer than a few weeks, and even for those who have a condition called spinal stenosis. Stenosis can be treated with surgery, but doctors usually recommend more conservative measures first to avoid potential complications, since physical therapy is much less invasive. Physical therapy could provide significant relief for patients with low back pain, therefore avoiding the need for surgery or other interventions and medications.
The DOD’s publication noted that physical therapy is considered a high-value treatment, in contrast to low-value treatments, which would include opioids as a first- or second-line treatment, bedrest, and surgery for non-specific back pain. These low-value treatments do not always have the best patient outcomes and can result in unnecessary healthcare costs and opioid dependence.
States Where the Program Is Available
Those who are over the age of 60 are more prone to lower back pain and problems. Unfortunately, physical therapy can be expensive, with co-pays as high as $41 for outpatient specialty visits for TRICARE Retired Reserve beneficiaries. These costs can add up for those on a limited income. For this reason, the program will include states with the highest TRICARE retiree population:
- North Carolina
The program is not limited to retirees, and anyone in these states can take advantage of the free therapy visits.
Within the ten states that are eligible for the program, there are some additional requirements:
- Only new physical therapy episodes will be eligible.
- The physical therapy appointment(s) must take place in an eligible state.
- Physical therapists and physical therapy assistants must be licensed.
- Physical therapists must be in-network with TRICARE.
Fortunately, there will be no limitation on the length of time between when the low back pain episode happened, and when the physical therapy will take place, the only limitation being that the beneficiary has not already had physical therapy for the same episode of back pain.
In addition, moving from an eligible state to a non-eligible state will disqualify beneficiaries for the free therapy, but a beneficiary who moves from a non-eligible state to an eligible one will qualify for free therapy if they meet the above guidelines.
Will this Program Be Permanent?
There is a potential for the demonstration to become permanent if patient outcomes improve and healthcare costs decrease. The program would then be made available to the entire TRICARE population.
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