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Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B
The Chiro.Org Blog
SOURCE: Spine J. 2013 (Jun 14) [Epub ahead of print]
Whedon JM, Song Y, Davis MA.
The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St, Lebanon, NH 03756, USA.
Electronic address: james.m.whedon@dartmouth.edu.
BACKGROUND CONTEXT: Concern about improper payments to chiropractic physicians prompted the US Department of Health and Human Services to describe chiropractic services as a “significant vulnerability” for Medicare, but little is known about trends in the use and cost of chiropractic spinal manipulation provided under Medicare.
PURPOSE: To quantify the volume and cost of chiropractic spinal manipulation services for older adults under Medicare Part B and identify longitudinal trends.
STUDY DESIGN/SETTING: Serial cross-sectional design for retrospective analysis of administrative data.
PATIENT SAMPLE: Annualized nationally representative samples of 5.0 to 5.4 million beneficiaries.
OUTCOME MEASURES: Chiropractic users, allowed services, allowed charges, and payments.
METHODS: Descriptive statistics were generated by analysis of Medicare administrative data on chiropractic spinal manipulation provided in the United States from 2002 to 2008. A 20% nationally representative sample of allowed Medicare Part B fee-for-service claims was merged, based on beneficiary identifier, with patient demographic data. The data sample was restricted to adults aged 65 to 99 years, and duplicate claims were excluded. Annualized estimates of outcome measures were extrapolated, per beneficiary and per user rates were estimated, and volumes were stratified by current procedural terminology code.
You may also want to refer to our:
Cost-Effectiveness of Chiropractic Page
and our
Medicare Information Page
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More on Chiropractic Cost Effectiveness
The Chiro.Org Blog
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655-662
Spinal Manipulation Epidemiology:
Systematic Review of Cost Effectiveness Studies
Michaleff ZA, Lin CW, Maher CG, van Tulder MW.
The George Institute for Global Health, The University of Sydney, Missenden Road, Sydney, NSW 2050, Australia. zmichaleff@georgeinstitute.org.au
BACKGROUND: Spinal manipulative therapy (SMT) is frequently used by health professionals to manage spinal pain. With many treatments having comparable outcomes to SMT, determining the cost-effectiveness of these treatments has been identified as a high research priority.
OBJECTIVE: To investigate the cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration.
METHODS: We searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Full economic evaluations conducted alongside randomised controlled trials with at least one SMT arm were eligible for inclusion. Two authors independently screened search results, extracted data and assessed risk of bias using the CHEC-list.
RESULTS: Six cost-effectiveness and cost-utility analysis were included. All included studies had a low risk of bias scoring ≥16/19 on the CHEC-List. SMT was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to GP care, exercise and physiotherapy.
There are many more articles like this @ our:
Cost-Effectiveness of Chiropractic Page
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 By Frank M. Painter, D.C. in Chiropractic Care on January 19th, 2013 at 8:40 pm
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
The Chiro.Org Blog
Med Care. 2012 (Dec); 50 (12): 1029–1036
Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, Karen J. Sherman, PhD, MPH, Daniel C. Cherkin, PhD, Bonnie K. Lind, PhD, Christine M. Goertz, DC, PhD, and William E. Lafferty, MD
Department of Orthopaedics, The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. brook.i.martin@dartmouth.edu
BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.
SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.
MEASURES: Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.
RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
CONCLUSIONS: CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
There are many more articles like this @ our:
Cost-Effectiveness of Chiropractic Page and our
Chronic Neck Pain and Chiropractic Page
From the Dynamic Chiropractic Article:
Chiropractic Costs: A National Perspective
First national study of CAM / chiropractic expenditures for spine conditions finds neither adds to overall medical spending.
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By Frank M. Painter, D.C. in Chiropractic Care on November 17th, 2012 at 11:17 pm
The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems
The Chiro.Org Blog
SOURCE: Med Care. 2012 (Dec); 50 (12): 1029–1036
The Geisel School of Medicine at Dartmouth & Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, NH
BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users
with spine problems.
RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.
SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.
MEASURES: Survey-weighted generalized linear regression and propensity matching to examine penditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.
RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users.
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By Frank M. Painter, D.C. in Chiropractic Care on August 14th, 2012 at 12:53 pm
Value of Chiropractic Services at an On-site Health Center
The Chiro.Org Blog
SOURCE: J Occup Environ Med. 2012 (Aug); 54 (8): 917-921 ~ FULL TEXT
Curt A. Krause, DC; Lisa Kaspin, PhD; Kathleen M. Gorman, MPH; Ross M. Miller, MD, MPH
From the Cerner Healthe Clinic (Dr Krause), Kansas City, MO; Cerner LifeSciences Consulting (Dr Kaspinand and Ms Gorman), Beverly Hills, CA; and Cerner Employer Services (Dr Miller), Cerner Corporation, Beverly Hills, CA.
OBJECTIVE: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.
METHODS: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes.
RESULTS: Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001).
CONCLUSIONS: These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.
There are numerous similar studies in our:
Cost-Effectiveness of Chiropractic Page
From the FULL TEXT Article:
Discussion
Although previous research has demonstrated the benefits of chiropractic care, to the best of our knowledge this study is the first to evaluate its impact when offered at an on-site health center. [6–10, 14–17] Given the convenience and quality of care provided by on-site health centers, it was hypothesized that on-site chiropractic care would be more beneficial than off-site clinic care. Despite some limitations that may have weakened the conclusions, the findings suggest on-site chiropractic services are associated with lower health care utilization of certain services and improved functional status of musculoskeletal conditions.
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Where the U.S. Spends its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions
The Chiro.Org Blog
SOURCE: Spine (Phila Pa 1976). 2012 (Mar 16)
Davis, Matthew A. DC, MPH; Onega, Tracy PhD; Weeks, William MD, MBA; Lurie, Jon MD, MS
Study Design Serial, cross-sectional, nationally representative surveys of non-institutionalized adults.
Objective To examine expenditures on common ambulatory health services for the management of back and neck conditions.
Summary of Background Data Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.
Methods We used the Medical Expenditure Panel Survey (MEPS) to examine adult (age ≥ 18 years) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.
Results Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008).
Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians.
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By Frank M. Painter, D.C. in Cost-Effectiveness on February 24th, 2012 at 2:26 pm
Chiropractic Research & Practice
State of the Art
The Chiro.Org Blog
Cleveland Chiropractic College
By Daniel Redwood, D.C., professor, Cleveland Chiropractic College
Peer Reviewers: Carl S. Cleveland III, D.C., J. Michael Flynn, D.C., Cheryl Hawk, D.C., PhD., Anthony Rosner, PhD.
©2010 Cleveland Chiropractic College – Kansas City and Los Angeles
Chiropractic Research & Practice
State of the Art
Since chiropractic’s breakthrough decade in the 1970s — when the U.S. federal government included chiropractic services in Medicare and federal workers’ compensation coverage, approved the Council on Chiropractic Education (CCE) as the accrediting body for chiropractic colleges, and sponsored a National Institutes of Health (NIH) conference on the research status of spinal manipulation — the profession has grown and matured into an essential part of the nation’s healthcare system.
Chiropractic was born in the United States in the late 19th century and the U.S. is home to approximately 65,000 of the world’s 90,000 chiropractors. [ 1] The chiropractic profession is the third largest independent health profession in the Western world, after medicine and dentistry. Doctors of chiropractic are licensed throughout the English-speaking world and in many other nations as primary contact providers, licensed for both diagnosis and treatment without medical referral. In 2005, the World Health Organization (WHO) published WHO Guidelines on Basic Training and Safety in Chiropractic, which documented the status of chiropractic education and practice worldwide and sought to ensure high standards in nations where chiropractic is in the early stages of development. [ 2]
Rigorous educational standards are supervised by government-recognized accrediting agencies in many nations, including CCE in the United States. After fulfilling college science prerequisites similar to those required to enter medical schools, chiropractic students must complete a chiropractic college program of four academic years, which includes a wide range of courses in anatomy, physiology, pathology, and diagnosis, as well as spinal adjusting, physiotherapy, rehabilitation, public health and nutrition.
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By Frank M. Painter, D.C. in Cost-Effectiveness on December 29th, 2011 at 8:48 pm
Zen and the Art of Chiropractic Maintenance
An Inquiry Into Health Care Values
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Anthony Rosner, PhD, LLD [Hon.], LLC
With all due respect to Robert Pirsig’s classic tome of the 1970s, [1] the book title couldn’t be more appropriately applied to both the state and lack of recognition of chiropractic health care.
As Pirsig explains in his introduction, the book itself isn’t an expostulation on orthodox Zen Buddhist philosophies, or for that matter motorcycles. Rather, it describes a journey with philosophical reflections along the way.
The same might be said of chiropractic’s own journey, in this case seeking proper recognition. In particular, chiropractic from the point of view of a variety of third-party payers has been repeatedly turned down for reimbursement when it comes to matters of maintenance or preventive therapy. Completely counterintuitive, you might say, in light of the repeated and sometimes urgent declarations that we hear to the effect that the only way to control the runaway costs and inefficiency of American health care is to emphasize preventive care, placing it at the highest rather than lowest priority of interventions. [ 2]
The evidence from recent research clearly demonstrates that the provision of maintenance or preventive measures from chiropractors appears to deliver tangible benefits, with major impacts upon our health care system:
Cost-Effectiveness
As part of a comprehensive geriatric assessment program, the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were not, and found that the individuals under continuing chiropractic care were:
- free from the use of a nursing home (95.7 percent vs. 80.8 percent);
- free from hospitalizations for the past 23 years (73.9 percent vs. 52.4 percent);
- more likely to report a better health status;
- more likely to exercise vigorously;
- and more likely to be mobile in the community (69.6 percent vs. 46.8 percent).
Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly health care interventions. [3]
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Chiropractic Cost-Effectiveness At Your Fingertips
The Chiro.Org Blog
The Path to Change in the US Healthcare System: Chiropractic Cost-Effectiveness
Thanks to the: Virginia Chiropractic Association
The following is a collection of studies relating to the cost effectiveness and efficacy associated with chiropractic care and the procedures that doctors of chiropractic provide. The American Chiropractic Association, The International Chiropractic Association, The Congress of State Associations, and the Association of Chiropractic Colleges appreciate the opportunity to provide these materials for your review.
All These Articles And More Are Available On Our:
The Cost-Effectiveness of Chiropractic Page
BACKGROUND STUDIES: (Regarding Medical Management)
Prognosis in Patients With Recent Onset Low Back Pain in Australian Primary Care: Inception cohort study
British Medical Journal 2008 (Jul 7); 337: a171 ~ FULL TEXT
This study contradicts Clinical Practice Guidelines that suggest that recovery from an episode of recent onset low back pain is usually rapid and complete. Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within after one year, while following standard medical management. This study was designed to determine the one year prognosis of patients with low back pain. 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the actual prognosis for the patients in the study.
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Chiropractic Cost-Effectiveness
The Chiro.Org Blog
SOURCE: Health Insights Today
By Daniel Redwood, DC
“Doctors of chiropractic are a vital part of our nation’s health care system. Your services have been proven both effective and cost-effective and every day you help countless Americans with a variety of health conditions.”
~ Kathleen Sebelius,
Secretary of Health and Human Services
2011 National Chiropractic Legislative Conference
Health care costs in the United States continue to rise and now account for 17.6% of the economy. In the public sector, Medicare and Medicaid budgets are under continual strain, while accelerating private sector insurance premium increases are pricing millions of American families out of the market each year.
Aside from outlawing pre-existing condition exclusions and providing premium subsidies for those who need them most, the Patient Protection and Affordable Care Act of 2010 (PPACA) empowers the Department of Health and Human Services to take a variety of steps toward controlling costs. But attempts to utilize these powers will trigger strong opposition from groups facing adverse impact to their bottom lines. Further complicating matters, the future of PPACA remains uncertain as opponents seek to vilify, defund and repeal it.
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By Frank M. Painter, D.C. in Cost-Effectiveness on February 24th, 2011 at 10:51 am
Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas
The Chiro.Org Blog
SOURCE: MGT of America, Austin, Texas
In 2002, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to workers’ compensation, the results of which were published in February 2003. According to the report, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low-back injuries. They found: Lower back and neck injuries accounted for 38 percent of all claims costs. Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs. These findings were even more intertesting: The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202. If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent, to $7,632.
Doctors of chiropractic have been licensed to practice in Texas since 1949 and have been a fundamental part of the state’s workers’ compensation system since 1953. Each year, Texas DCs treat tens of thousands of injured workers, but until recently, little data were available comparing the cost-effectiveness and efficacy of chiropractic versus other forms of care available through the workers’ compensation program.
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By Frank M. Painter, D.C. in Cost-Effectiveness on January 26th, 2011 at 2:36 pm
Newly Published Study Confirms That “Maintenance Care” Delivers!
The Chiro.Org Blog
This new, single blinded placebo controlled study, conducted by the Faculty of Medicine at Mansoura University, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain. [1]
The authors concluded that spinal manipulation is effective for the treatment of chronic nonspecific LBP and that to obtain long-term benefit for the patient, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy can provide that additional benefit.
SOURCE: Spine (Phila Pa 1976) 2011 (Aug 15); 36 (18): 1427-37
BACKGROUND: Spinal manipulation (SMT) is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance SMT in chronic non-specific LBP has never been studied.
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