Introduction
Musculoskeletal (MSK) conditions drive substantial health care costs in the United States, affecting a large share of adults and imposing both direct medical expenses and indirect costs like lost productivity. Recent efforts to modernize MSK care focus on rapid access, high-quality rehabilitation, and coordination within primary care. This article reviews a study examining a tele-physical therapy (TPT) model embedded in an integrated advanced primary care system and its effects on access, functional outcomes, patient experience, and potential cost savings.
What makes an integrated advanced primary care model different?
The model analyzed combines a multidisciplinary team—including primary care providers (PCPs), behavioral health, health coaching, and musculoskeletal rehabilitation care—within a shared digital platform. A musculoskeletal toolkit guides PCPs toward evidence-based pathways, with TPT available via synchronous video visits or in-office sessions. A peer-to-peer musculoskeletal expert portal and routine musculoskeletal educational rounds further support clinicians, aiming to streamline care and reduce unnecessary steps such as imaging and specialist referrals.
Methods at a glance
The study retrospectively evaluated 1,563 adolescents and adults with MSK concerns who engaged with TPT from January 2021 to December 2023 in a California-based system. Exclusion criteria focused on incomplete data or single-visit cases. Outcomes were compared with FOTO (Focus on Therapeutic Outcomes) controls—an extensive rehabilitation outcomes database. Measures included access to care (time to see PCP and time to start PT), patient-reported functional status (FOTO score), provider-reported progress, patient satisfaction, and direct costs of PT care.
Key findings: access, outcomes, and satisfaction
Access to care: The median time to a PCP appointment was 6.6 days, and PT started about 7.6 days after insurance approval, indicating rapid access compared with traditional pathways.
Functional outcomes: TPT embedded in advanced primary care yielded statistically and clinically meaningful improvements in function. For knee, lumbar spine, and neck pain, functional status residuals favored the TPT group (e.g., knee pain residual of 5.82; lumbar spine 5.70; neck 5.07; all P<.05). Across other body parts, improvements were also observed, though not always statistically significant due to smaller sample sizes.
Visit burden and efficiency: On average, TPT participants needed 5.41 visits to symptom resolution, substantially fewer than FOTO-predicted visits (10.3) and FOTO controls (6.49). The integration and guideline-driven care likely contributed to faster recovery with fewer visits.
Provider and patient experience: Providers reported that 97.5% of evaluated patients were progressing toward goals (meeting, mostly meeting, or on track). Patient satisfaction, measured via net promoter score, was high (NPS 97) with a strong response rate given the remote setting.
Costs: Direct PT costs ranged from $176–$288 per visit. Savings were estimated per injury, ranging from $193 to $1,411, driven by fewer PT visits; broader cost reductions (imaging, injections, or specialty care) were not included in this analysis.
Interpretation: what does this mean for MSK care?
The study supports the viability of an integrated advanced primary care model that embeds TPT within the primary care workflow. Benefits include faster access to care, meaningful improvements in functional status, reduced treatment visits, and potential cost savings. The model also highlights the value of ongoing PCP–MSK specialist collaboration, including real-time consults and shared patient information, to coordinate care efficiently and reduce unnecessary services.
Limitations and future directions
Notable limitations include the focus on commercially insured populations and a California-centric sample, which may affect generalizability. Only a subset of participants completed satisfaction surveys, and full cost analyses beyond PT visits were not conducted. Future work should examine mental health outcomes, access in rural or economically disadvantaged groups, and a more comprehensive economic assessment that includes avoided imaging and preventive care savings. Expanding to Medicare populations and diverse geographies will help validate these findings across the U.S. health system.
Conclusion
When musculoskeletal care is integrated within an advanced primary care framework, tele-physical therapy can deliver substantial clinical gains with fewer visits and strong patient satisfaction. This approach may help address rising MSK costs while improving patient-centered outcomes for a broad and diverse patient population.
