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A new study published in the February 1 issue of Spine concludes that a consultation with a physical medicine and rehabilitation (PM&R) physician before proceeding to surgery results in more efficient treatment for low back pain, high patient satisfaction, and fewer surgeries.

“The Effect of Required Physiatrist Consultation on Surgery Rates for Back Pain” reports data from Priority Health, an insurance company that began to require that its patients with nonurgent, spine-related pain or disability see a PM&R physician, also known as a physiatrist, before proceeding to surgery. After one year, there was a net decrease of more than $14 million in total spine care costs.

Priority Health created its Spine Centers of Excellence program in an effort to reduce the health care costs of low back pain, especially the number of unnecessary surgeries. Many studies have found that non-surgical care for back pain is as effective as surgical care. To qualify for the program, a practice had to meet several criteria including the requirement of being staffed by a board certified PM&R physician, use of evidence-based treatment guidelines, and membership in the North American Spine Society or another organization specifically dedicated to the treatment of spinal disorders, including the American Academy of Physical Medicine and Rehabilitation (AAPM&R).

As a result of patients consulting with a PM&R physician before any surgical referrals, the number of spine operations dropped 25% and referrals for surgery decreased 48%. Patient satisfaction with this treatment for their back Continued next page pain increased. Over 70% of the patients surveyed were satisfied or very satisfied with the physiatric consultation they received.

The Institute for Healthcare Improvement (IHI) has encouraged the support of its Triple Aim goals for future delivery of health care in the US. The Triple Aims are: 1) improve the health of the population, 2) enhance the patient experience of care, and 3) reduce or control the cost of care. AAPM&R concludes that data from this study shows the vital role PM&R plays in the future of health care in meeting these triple aims with a focus on function.