Controlling the Cost of Rehabilitative Care
When was the last time you reviewed the cost of post-operative or post-traumatic rehabilitative care?
Joint Active Systems (JAS) has been playing a leading role over the past 30 years to reduce rehabilitative cost as a component of operative care. Recently we experienced an event with our insurance plan causing us to reevaluate the cumulative cost of surgical intervention to the lower extremity.
During the 2021-2022 insurance cycle, JAS was notified of a 34% increase in our insurance premiums based on claim history. Upon further review, the greatest financial impact came from seven orthopedic cases; 3 total hip replacements, 3 TKAs, & 1 ACL reconstruction. We were surprised to discover only 64% of the fees were generated by surgical fees, anesthesiology, radiology, and hardware (implants). The remaining 36% came from fees associated with rehabilitation and therapeutic services. We did not include additional cost of pharmaceuticals.
As a company, we understand rehabilitation as a percentage of operative care, but were shocked to realize how drastically this has grown over the years. For example, in rural Illinois, 2 years ago, one thirty-minute physical therapy session cost approximately $300 per visit. This year, we were consistently billed $484.00 (exclusive of additional coding events) for one thirty-minute physical therapy visit. When additional codes are utilized to optimize billing, the cost of a visit increases exponentially. Looking at one of our employee’s insurance disbursements for bilateral THR, surgical cost was $70,000 with rehabilitative costs of $40,000. There were no reported complications.
Post-operative protocols vary based on practitioner instruction. In our experience, an average post-op protocol falls in the range of 18-20 visits, accomplished in 2-3 rehab appointments per week.
3 visits per week x 6 weeks = 18 visits at $300/visit= $5400.00 (2020)
3 visits per week x 6 weeks = 18 visits at $484.00/visit = $8712.00 (2022)
1 month of JAS averages under $300/month, less than the cost of an average single therapy visit
Successful JAS outcomes are shown in over 30 published clinical studies including the largest prospective rehabilitation study in the US, appearing in Annals of Translational Medicine in 2018. Over the course of 10 years, 6000 patients from a base of 167,751 treated with a JAS brace were interviewed on their experience. Of the 6000 patients interviewed, 90% experienced increased range of motion, decreased pain, stiffness, and swelling. Of the 167,751 patients there were no complications reported.
Despite the resounding evidence of cost savings and effectiveness, many insurance companies have reduced access to adjunctive therapy products, such as JAS. We have experienced the first-hand impact of increasingly adverse insurance medical policy and restrictive criteria. Over time, this has created a negative impression among many potential referring practitioners. The net impact is a reduction of utilization adjunctive devices such as JAS, with an increasing path to intervention such as MUA, surgical release, and further rehabilitative/therapeutic care.
The single greatest source for cost savings is early intervention. By implementing JAS before the earliest onset of joint stiffness, minimize the risk of complications, maximize patient compliance, , and improve the patient outcome. JAS welcomes any practitioner interested in furthering this discussion. For more information, or If you wish to share cost data relevant to rehabilitative cost as a component of your patient care please contact us.