Paper #62 - ISHA Annual Scientific Meeting 2016

Physical Therapy Utilization After Hip Arthroscopy: A National Perspective

Jonathan Alexander Godin, MD, MBA, Durham, NC UNITED STATES
Richard C. Mather, MD, MBA, Durham, NC UNITED STATES

Duke University Medical Center, Durham, North Carolina, UNITED STATES

FDA Status Not Applicable

Summary: This study evaluates the demographics of physical therapy utilization after hip arthroscopy procedures in a large national database of insured patients.

Abstract:
Purpose: To evaluate the demographics of physical therapy (PT) utilization after hip arthroscopy procedures in a large national database of insured patients.

Methods: The PearlDiver insurance database was queried for patients receiving post-operative PT following hip arthroscopy procedures between 2007 and 2014 using Current Procedural Terminology codes. The following CPT codes for hip arthroscopy procedures were included in this study: CPT-29861, CPT-29862, CPT-29863, CPT-29914, CPT-29915, CPT-29916. Seventeen PT-related CPT codes were selected with the guidance of physical therapists at our institution. PT utilization was determined by the percentage of patients with at least one post-operative PT-related code.

Results: The number of hip arthroscopies increased by more than 400% throughout the study period (R2=0.98, p<0.01). PT utilization within 6 months increased from 65% to 82% throughout the study period (R2=0.96, p<0.01). Females displayed a slightly higher rate of PT utilization compared to males (79% vs 75%, p=0.08). Hip arthroscopy was most commonly performed in patients between the ages of 35 to 54 years, while PT utilization was significantly higher in patients younger than 55 years of age compared to older patients (86% vs 71%, p<0.01). Patients who underwent CPT-29914 (femoroplasty) or CPT-29916 (labral repair) had a significantly higher rate of PT utilization than patients who underwent other arthroscopic hip procedures (88% vs 72%, p<0.01). Patients with commercial insurance had a significantly higher rate of PT utilization than those with Medicare (83% vs 66%, p<0.01). CPM utilization was 4% at 6 months in this database cohort. The rate of a second hip arthroscopy procedure within 2 years from index procedure was significantly higher in patients who participated in post-operative PT (10.8% vs 5.7%, RR = 1.90, 95% CI 1.27-2.86, p = 0.001). Manual therapy was utilized in a significantly higher percentage of patients who did not go on to a second hip arthroscopy compared to those who did not (94.1% vs 77.3%, RR = 3.88, 95% CI 2.75-5.47, p < 0.001). Of the patients who participated in PT, privately insured patients underwent a second hip arthroscopy within 2 years of the index procedure at a significantly higher rate than Medicare patients (12.3% vs 6.7%, RR = 1.83, 95% CI 1.23-2.74, p = 0.002). There were no differences in PT utilization between obese and non-obese patients, or between patients who went on to receive a total hip arthroplasty within the study period and those who did not.

Conclusions: Both the number of hip arthroscopy procedures and the utilization of PT following these procedures increased significantly within the study period. While there was not a significant difference in PT utilization based on gender, younger, commercially insured patients were more likely to participate in PT than their older, Medicare-covered counterparts. Moreover, there was a significant difference in PT utilization rates based on the procedure performed. Manual therapy utilization differed significantly between patients who did or did not undergo a second hip arthroscopy. Finally, CPM use in the post-operative period was low in this cohort.