A new study from the Duke Clinical Research Institute (DCRI), in collaboration with Duke Orthopaedics and ATI Physical Therapy, reveals that eliminating copays for physical therapy can reduce the utilization of downstream healthcare services—including imaging, injections, and surgery—among patients with musculoskeletal conditions.
Published in the Physical Therapy & Rehabilitation Journal and utilizing real-world data, the study examined outcomes from a no-copay physical therapy program implemented with a large Midwest self-insured employer. Launched in 2018, the program encouraged physical therapy as a first-line treatment for over 50,000 adult beneficiaries. More than 70% of participants received physical therapy on the first day of their care episode.
Compared to traditional medical pathways, patients in the no-copay program experienced:
- 7% fewer imaging and inpatient care episodes
- 16% fewer surgery/injection episodes
- 57% fewer physician service episodes
“These findings demonstrate that reducing financial barriers to physical therapy can lead to more effective, evidence-based care,” said Trevor Lentz, PT, PhD, MPH, associate professor in the Department of Orthopaedic Surgery at Duke and principal investigator of the study.
“Given the increasing costs of musculoskeletal care, payers and health systems should consider policies that enable patients to access conservative care earlier in their treatment process.”
The study also found that even when compared to other physical therapy episodes outside the ATI no-copay program, the no-copay group had:
- 9% fewer imaging episodes
- 38% fewer physician service episodes
Chad Cook, PT, PhD, MBA, FAAOMPT, professor of Orthopaedic Surgery at Duke, added: This research reinforces what we’ve long advocated—early, accessible physical therapy not only improves patient outcomes but also cuts unnecessary healthcare use. It’s a win for patients, providers, and payers alike.
Steven George, PT, PhD, Lazlo Ormandy Distinguished Professor of Orthopaedic Surgery and Therapeutic Area Lead at DCRI, also contributed to the study as a co-author.
This research adds to a growing body of evidence supporting early conservative care as a cost-effective and clinically sound approach to managing musculoskeletal conditions.