Cost of care for ambulatory patients with low back pain

Low back pain is a common presenting complaint in primary care, and the rate of utilization of resources among physicians treating this condition varies. Charges associated with the care of patients with low back pain were analyzed for a series of patients in a multispecialty group practice setting.

One hundred seventy managed care patients were selected for review. Use of laboratory, plain radiography, magnetic resonance imaging (MRI), subspecialty referrals, and physical therapy was examined based on patient characteristics and physician specialty. Appropriateness of MRI and lumbar spine radiography according to published criteria was also studied.

Overall utilization was higher for patients who were referred to a subspecialist, and costs for visits to subspecialists were higher. Charges for physician services and MRI accounted for a majority of the total charges. Patients who were referred for subspecialty care or MRI but did not meet criteria for utilization of these resources comprised 6% of the study population but accounted for 27% of the total charges. Five of 14 patients undergoing MRI did not meet the published clinical criteria determining need for MRI, and 10 of 17 patients referred to subspecialists did not meet referral criteria. Other patients who met criteria for MRI or subspecialty consultation did not receive these services. Seventeen percent of the patients referred for physical therapy had a symptom duration of 2 weeks or less at the time of referral and accounted for 17% of all physical therapy charges.

The majority of costs associated with care for low back pain in this study were attributable to physician charges and the use of MRI. Charges for subspecialty physician services, lumbar spine radiographs, and MRI in patients not meeting appropriate criteria accounted for 19% of all costs.