High-Value Low Back Pain Care Uncommon Among Medicare Advantage Beneficiaries Receiving Follow-Up Care

Guidelines recommend nonpharmacological therapies, including physical therapy (PT), as first-line treatment for low back pain. This retrospective cohort study used a 20% random sample of 2021 Medicare Advantage outpatient and carrier encounter data to examine care among 181,980 beneficiaries aged 66 years or older with a new diagnosis between April and September 2021. Researchers followed beneficiaries for 90 days and classified care as high or low value according to the timing and receipt of PT, imaging, and spinal injections.

Among 87,305 beneficiaries receiving additional care during follow-up, 21.6% received high-value care and 78.4% received low-value care. Imaging without PT was the most common low-value pattern; PT alone was the most common high-value pattern. Older age, Hispanic ethnicity, multiple comorbidities, lower plan ratings, and initial visits with surgeons or pain specialists were associated with lower odds of high-value care. Rural residence and greater neighborhood socioeconomic deprivation were also associated with lower receipt.

The findings identify potential gaps in access to guideline-concordant management for older adults. However, the reported percentages apply to beneficiaries receiving additional care, not the entire cohort. The observational design does not establish causality, and the available abstract does not provide adjusted effect estimates or detailed classification criteria. Outcomes concerned care patterns rather than changes in pain or function.