Variation in High Value Care for Low Back Pain Among Older Adults Enrolled in Medicare Advantage Plans

Low back pain (LBP) is a major cause of disability and poor quality of life among older adults. Clinical guidelines recommend non-pharmacological therapies, such as physical therapy (PT), as the first-line treatment for high-value care. Despite the fact that more than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), there is no knowledge about the patterns of high-value LBP care within this population.

To characterize high- and low-value LBP care among MA beneficiaries and identify factors associated with receipt of high-value care.

We conducted a retrospective cohort study using a 20% random sample of 2021 MA outpatient and carrier encounter data. Beneficiaries aged ≥ 66 years with a new LBP diagnosis between April 1 and September 30, 2021, were followed for 90 days. The study outcomes include high- and low-value care, defined by the timing and receipt of physical therapy, imaging, and spinal injections.

Among 181,980 beneficiaries with newly diagnosed LBP, 87,305 received additional care within 90 days. Of these, 21.6% received high-value care and 78.4% received low-value care. Imaging without PT was the most common low-value care pattern, whereas PT alone was the most common high-value care pattern. Older age, Hispanic ethnicity, multiple comorbidities, lower MA plan ratings, and index visits with surgeons or pain specialists were associated with lower odds of receiving high-value care. County-level variation was observed, with rural residence and greater neighborhood socioeconomic deprivation associated with lower receipt of high-value care.

Most older adults enrolled in MA plans with LBP did not receive guideline-concordant, high-value care. Geographic and socioeconomic disparities highlight opportunities to improve equitable access to evidence-based LBP management in older adults enrolled in MA plans.