Defining and Categorizing Low-Value Physical Therapy Referral Waste in Acute Care: An Administrative Case Report

Hospitals can follow the steps outlined in this administrative case report to identify and address potential overutilization waste.

Acute care physical therapist evaluation and intervention can identify functional needs, safety needs, and develop treatment plans to optimize function, activity, safety, and the ability to discharge home safely. However, health care waste results when therapy referrals are utilized beyond these needs. This administrative case report aimed to define and categorize physical therapist overutilization to guide health care waste reduction.

This administrative case report describes a 2-phase project to develop and implement a low-value referral (LVR) tracking system within a large health care system. During phase 1, the development phase, semi-structured group consensus meeting stakeholders identified 4 LVR categories and developed a data collection tool for a hospital-wide feasibility project. Phase 2 collected data on clinician-identified LVRs over a 2-year timeframe to identify LVR category, referring provider, and patient care unit from which the LVRs are located.

Baylor University Medical Center (BUMC) is a quaternary care academic medical center in Dallas, Texas, with 914 licensed acute care beds.

All physical therapists evaluating and treating patients at BUMC during the project.

Out of 40,815 total physical therapist referrals, 2263 were identified as LVRs. The authors found that 5.54% of hospital referrals were LVRs, with more than 75% of LVRs associated with patients currently at their baseline functional state and/or independent with activity/mobility. Furthermore, 27% of all LVRs came from just 20 referral sources (mean = 30.55; SD = 9.76), and 43.9% were located on 3 patient care units, making targeted and customized education and collaboration initiatives feasible.

This case report demonstrates that acute care hospital physical therapist overutilization can be easily defined by category, source, and location. This meaningful data can be used to divert potential health care waste toward evidence-informed patient care designed to improve outcomes.