Walk-in Physical Therapy Leads to Fewer Tests, Lower Costs, Study Finds

February 11, 2013

Walk-in urgent care centers such as University Health System’s ExpressMed clinics are increasingly popular, accommodating the hectic schedules of busy families. But walk-in physical therapy?

While instant access to physical therapy is unusual today, the results of a year-long study found it might be worth a broader look.

The study, involving patients seen at the ExpressMed clinic on the Robert B. Green Campus, found that putting appropriate patients with a therapist immediately — or within three days at the most — led to fewer treatments, fewer tests and more patient satisfaction. Overall, the medical charges for those patients came to $1,500 less per patient.

Amit Mehta, director of ambulatory therapy services at University Health System, who led the study, said the normal route taken by patients with musculoskeletal problems like low-back pain — from diagnosis to physical therapy — can take weeks.

The primary care doctor might refer the patient to a physician specialist, who might order an MRI. A second appointment to discuss the results of the scan and rule out surgery might then lead to a referral for physical therapy.

“From the time they’d see the primary care physician to the time they got physical therapy, sometimes two or three months would pass,” Mehta said. “A lot of these patients, who are really acute with new back pain, now are developing a chronic condition which is harder to treat, and takes longer to treat.”

Over the course of the study, a physical therapist was assigned to the ExpressMed clinic twice a week for four hours a day, to treat patients referred by a doctor on the spot. That schedule coincided with the operation of the Body-in-Motion Center, a special clinic staffed by ExpressMed primary care physicians to treat musculoskeletal problems. Some patients who couldn’t be seen immediately were treated within three days.

The study compared 308 walk-in patients to 1,451 patients seen through traditional referral patterns. The walk-in patients required an average of eight procedures, compared to 14 for the patients seen through the traditional model. Walk-in patients had fewer X-rays, and were half as likely to undergo a CT-scan or MRI.

The study, presented at a meeting of the American Physical Therapy Association in San Diego in January, was awarded the best research poster presentation in the health policy and administration section.

And although the ExpressMed clinic no longer has an on-site physical therapist since the experiment ended, the results were promising enough that the downtown physical therapy clinic at the Robert B. Green Campus — located a short walk from ExpressMed — still accommodates walk-in patients. University Health System’s Reeves Rehabilitation Center operates inpatient and outpatient clinics at University Hospital, along with the downtown clinic and two other sites.

Co-authors of the paper were physical therapist Matthew Walk; Dr. Liem Du, medical director of the ExpressMed clinic; and Dr. Bhoja Katipally, a family medicine physician. Both Drs. Du and Katipally are with Community Medicine Associates, the physician practice organization of University Health System.