Health Care Cost Savings and Utilization Reductions Associated With Virtual Physical Therapy Care: A Propensity-Matched Claims Analysis

Abstract

Objective: The objectives of this study were to evaluate the differences in medical costs and health care utilization between patients receiving virtual physical therapy (V-PT) care and patients receiving in-person physical therapy (IP-PT) care (controls) over 6 and 12 months.

Methods: This study used claims data from July 2019 to May 2023. The index date was defined as the initial video (V-PT) or in-person (IP-PT) (controls) physical therapist evaluation date. Patients receiving V-PT (n = 342) were 1:3 propensity score matched to controls receiving IP-PT (n = 1026). Median difference-in-difference per-member-per-month (PMPM) estimates, differences in median postindex costs between groups, and return on investment at 6 and 12 months were estimated. Utilization was evaluated as the postindex mean difference in encounter counts.

Results: There were significant gross PMPM savings among patients in V-PT versus those in IP-PT at 6 and 12 months in total costs (-$104.70 vs - $64.10) and musculoskeletal (MSK) condition-related total costs (-$99.56 vs - $49.80). After inclusion of the cost of virtual care, patients receiving V-PT experienced significant net PMPM savings in 6-month MSK condition-related total costs (-$21.20) and 6- and 12-month physical therapy costs (-$25.05 vs - $8.22). These patients experienced significantly lower 6- and 12-month gross MSK condition-related postindex costs than patients receiving IP-PT (-$1059 vs - $1049) which translates to a 1.8-times return on investment at both time points. Patients in V-PT utilized significantly fewer total health care services, MSK condition-related total services, and physical therapist services than patients in IP-PT at 6 and 12 months.

Conclusions: V-PT care may be a meaningful driver of MSK condition-related cost savings by providing a cost-effective and accessible alternative to IP-PT care.

Impact: V-PT care provides an accessible platform for clinically appropriate patients to engage in physical therapy in a cost-effective way. Increasing awareness and utilization of V-PT care may reduce medical costs related to MSK conditions.

Lay summary: To the author's knowledge, this is the first real-world health care claims analysis to evaluate costs and utilization of V-PT care compared to IP-PT care in treating musculoskeletal conditions. This study suggested that V-PT care was associated with cost savings and lower utilization for total medical care and musculoskeletal condition-specific care compared to IP-PT, with reductions driven by physical therapy costs and encounters.

Keywords: Health Care Claims; Musculoskeletal; Physical Therapy; Propensity Score Matching; Real-World Data.