Utilization and Payments of Office-Based Physical Rehabilitation Services Among Individuals With Commercial Insurance in New York State

Background Limited research exists on the utilization and payments of physical rehabilitation services, especially among individuals with commercial insurance.

Objective This study aimed to characterize the utilization and payments of office-based physical rehabilitation services among nonelderly individuals with commercial insurance from New York State.

Design This was a retrospective descriptive study with a cross-sectional design.

Methods A cohort of 1.8 million individuals in the 2012 Truven Health MarketScan Research Database was constructed for review. A total of 109,821 unique patients who received any type of physical rehabilitation provided by physical therapists, chiropractors, and physicians in the office setting were included for analyses.

Results Physical therapists provided the largest proportion of physical rehabilitation services (54.5%), followed by chiropractors (27.5%) and physicians (18.0%). Six out of 100 individuals used physical rehabilitation services in 2012. The mean annual payment of physical rehabilitation per patient was $820 (median=$323). Women and older individuals were more likely to use rehabilitation services and have higher annual utilization and payments. For the 5 most common physical rehabilitation services, payment rates for chiropractors were the highest and those for physical therapists were the lowest, with payment rates for physicians in between.

Limitations This study was based on commercial insurance claims data from one state.

Conclusions Findings from this study recognize that rehabilitation services are delivered by various types of health care professionals and the payment rates vary across provider specialties in New York State. Of particular interest is that although physical therapists provide the largest proportion of services, their payment rates are lower than the rates for chiropractors and physicians. Future research should assess regional variations and explore interprovider cost-effectiveness in delivering these interventions.