Episode 24: The Economics of PT-First | Real Data on Cost Savings and Outcomes

How crazy is it that proven interventions in healthcare take so long to spread, even when they show clear economic and clinical benefits?Innovation in healthcare is painfully difficult to get into widespread adoption, even after proven successful. This episode discusses the results of a nine year-old study at Geisinger Health System on a PT-First "bundle" that's just as relevant today. But the disturbing part about it is it's not common to find a structure like this one, where a shift in incentives changed the care pathway for patients. Here are major takeaways from the episode:PT-First Models Are Economically Proven: When properly structured with the right incentives, physical therapy as a first-line intervention for musculoskeletal conditions reduces costs and improves outcomes. This has been demonstrated at scale.Risk Stratification Is Your Friend: Implementing tools that identify high-risk patients (for joint replacement, high utilization, poor psychosocial factors) helps you target PT-first interventions where they'll have the most impact.Understand the Regulatory Landscape: Know the difference between what commercial plans can do versus Medicare constraints. This helps you understand why some innovations work in certain settings but not others, and where to focus your advocacy efforts. And don't forget to explore CMS Innovation Center Models! They are a key opportunity for Medicare to offer flexibilities outside of statute and PTs and OTs can 100% benefit from this!Patient Incentives Matter as Much as Provider Incentives: Waiving or reducing copays for PT-first approaches changes patient behavior. Consider how your practice can work with payers to create these incentives.Think Beyond Traditional Treatment: The food-as-medicine example challenges PTs to consider all drivers of health outcomes, not just manual therapy and exercise. What are the non-medical factors affecting your patients' success?Health Systems with Their Own Plans Are Innovation Leaders: These integrated systems have the most flexibility and motivation to try new models. Consider targeting these organizations for partnerships or employment.The "Why Not Everywhere?" Question: Just because something works doesn't mean it spreads quickly in healthcare. Understanding the barriers to adoption (regulatory constraints, organizational inertia, population mix) helps you be more strategic about implementing change.Keep It Simple: As Alex notes - "kiss things" "(keep it simple, stupid"). The most successful innovations have clear, straightforward incentive structures that are easy for patients and providers to understand and act on.Find the article we discuss in this episode on a PT-First payment model here.Sign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy. Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians.Subscribe to our YouTube ChannelWe also discussed in this episode the "Geisinger Fresh Food Farmacy" research. The pilot evaluated whether providing free, healthy food for the entire household of a food-insecure adult with Type 2 diabetes improves health outcomes and reduces healthcare use. In the podcast, Dana described what she recalled from memory. The study is found here but we can't find access to the article unlocked. Asking "Claude.AI," it said in this observational pilot study with 37 participants showed a 2.1% average drop in HbA1c levels and an 80% reduction in healthcare costs (from $240,000 to $48,000 per member per year). Additional research has recently been published put we can't locate it unlocked online. It looks like funding was from the 2018 Farm Bill.