Back pain patients get fast therapy with St. Luke's spine program

Bethlehem, Pa.-based St. Luke's University Health Network Wednesday unveiled its program that ensures patients with lower back pain get timely access to physical therapy services before the condition worsens and requires surgery or pain medications.

Back pain can worsen to a chronic condition if left untreated, which often leads to costly procedures and opioid dependency. In fact, lower back pain is one of the most common conditions treated with opioids.

St. Luke's Comprehensive Spine program is designed to prevent the development of chronic back pain among patients by addressing the issue sooner with physical therapy. About 85% of back and neck patients at St. Luke's can be treated appropriately with physical therapy. Just 15% of cases should be referred to a surgeon or other advanced specialists, according to the health system.

"It's about getting people early to the right person," said Dr. Aldo Carmona, senior vice president of clinical integration at St. Luke's who led implementation of the program. "The quicker and more effectively people are treated the less chance they will enter into chronicity. We are trying to stem that tide."

St. Luke in mid-July implemented a call center staffed by three nurses who refer patients that present to a St. Luke's emergency department, urgent-care center or primary-care office with lower back pain. The nurses are trained to screen patients to determine if they require physical therapy or, for patients with severe back issues, should be referred to a surgeon.

The nurses book the patient with a physical therapy appointment no later than 48 hours after they have presented to a St. Luke's site. Patients can also call the center for a referral.

Before the call center, there was no guarantee patients would be seen that quickly because different areas of St. Luke's handled lower back pain cases differently, Carmona said.

St. Luke's already operated comprehensive physical therapy services before the program was adopted. The system has 50 physical therapy sites staffed with physical therapists trained in lower back pain treatment.

But St. Luke's made additional financial investments in the program including hiring nurses, a physiatrist and an advanced practitioner. Office hours at physical therapy offices were also extended.

Patients with moderate back pain will likely only need one or two sessions to address the problem, Carmona said. The health system also helps educate patients about their condition and how best to address it, including appropriate physical activity. Further, as part of the program, physicians across the network were given a refresher on guidelines for appropriate testing and X-rays for back pain, which can be inappropriately ordered and overused.

Since the program was implemented, about 150 referrals have been made. Carmona expects the referrals will only grow because lower back pain is such a common condition and patient outreach about the program is just starting.

A few other health systems across the country like Virginia Mason Medical Center and the Ohio State University Wexner Medical Center have adopted similar programs. It's an opportunity for health systems to lower costs by helping patients before their condition becomes chronic and costly.

"We do believe we are going to have an effective low-cost alternative to treating patients with low back pain," Carmona said.