This review, was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.
Executive Summary:
Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.
The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.
High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.
The results of the researchers’ analysis are as follows:
-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.
Total cost of care per year:
-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.
-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.
Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.
These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.
The full report can be downloaded here.
I appreciate the positive tone of this article if you will. Having said that, I personally believe that qualified/licensed practitioners providing equal services should be paid the same. For too long chiropractor groups go to the negotiating table and get low balled. Yes, I understand p.t.(s) are under similiar pressures but i feel there’s inequality/discrimination regarding reimbursement. Our reward as chiropractors with overall positive patient outcomes is the ability to participate. Not equality. While positive studies come out here and abroad regarding chiropractic treatment some physical therapy groups are replicating our model of care. We can continue to have our identity/philosophy but we must become/remain competitive with the physical therapist strategy. We should be able to go to the negotiating table and get what physical therapists get for the same services/procedures.
It’s a sad story of politics as usual, and unfortunately, we are to blame. In 1995, at the Centennial of Chiropractic Celebration in Washington, DC, about 800 chiropractors showed up. At the same time (in DC) the APTA held their yearly meeting, and almost 8,000 showed up. So, if you were a politician, who would you listen to?
I agree with you regarding equity issues. I’m a BCBS provider, and note that although my adjusting charges are reduced by $10 (18%) for a CMT-2, the PT codes I use are only reduced by 5 (11%). In Medicare, every year they try to reduce remuneration for CMT, while the E&M codes (the most common code used by medicine) continues to inch up 4-8% every year. Must be nice.
This profession can’t improve it’s situation while less than 15% join National Associations to fund the political action. That’s just a cold hard truth.
“That’s just a cold hard truth” no doubt this profession needs to unite and have a collective presence. For some this is a catch-22 as some practitioners enjoy/relate to individualism. I totally understand the idealism of being an individual but the profession needs to understand the power of one if you will. Our perceived strength can be/is our weakness. Most chiropractors go into business for themselves so they essentially compete with other chiropractors as well as other physical medicine practitioners. this in it self causes fragmentation of the profession. We must have a collective message that allows individualism. This must happen to compete in the physical medicine environment. The physical therapists have a major strategy to dominate the non-surgical physical medicine turf.
We have been and still remain a splintered profession. Because of the various sub-groups within chiropractic, we can’t unit with one voice and concentrate our focus to help pass protective legislation which would benefit all of us. What’s worse is that I don’t see it getting better any time soon. The same problems which have plagued us for the past 100 years show no sign of letting up.
Well, there’s also another way to look at it. It takes a unique individual to ignore all that allopathic programming, to be open-minded enough to see the Big Picture, and to see chiropractic as a worthy profession. There’s no doubt that each of us could have become MDs or DOs, but here we are, marching to a different drummer.
So our greatest failing (not marching lock-step) is also our great strength. We are a profession of mavericks, rebels, and leaders! Will that lead to sectarian struggles? Sure…too many cooks, and not enough bottle-washers (or joiners).
That never stopped the DCs of the past from rallying around when the need was there, and I expect to see that happen again during the big Health Care cake cutting ceremony planned by Congress. It’s time for the profession to speak with One Voice.
I agree with dr. smith. we need a clear message about our philosophy and how we fit into the health care system. I said it earlier the physical therapists are encroaching within our territory. Is that good or bad it depends nevertheless we need a clear message and we need to stop eating our own. We are fragmented that may seem great to some but we need a collective presence. We need more preventive strength instead being reactive to a problem. Beyond the patient satisfaction which is rewarding getting a fair/equal reimbursement would help us all stay in business.
Friends,
We ARE different from medics. We DO march to the beat of a different drummer. And we should continue to do so (otherwise we will have no identity whatsoever).
Now that being said, if we are to muster our political strength, we need to get organized and united. We need to establish a standard of care which defines who we are and what we do. As it is, chiropractic is like Baskin Robbins…31 flavors, something for everybody. Anyone can conjure up some technique in their garage on a Wednesday and be teaching it in Holiday Inn banquet rooms on Saturday – to a group of other chiros, and in exchange for some super deluxe certification and a promise that people will be lining up around the block to come see them! It’s sad and I mostly blame the chiropractic colleges and the CCE for not stepping up to unify our approach to care.
Our philosophy (call it a mission statement if that’s more comfortable for you) essentially defines what we do, and what our scope of care should be. We’ve got too many splinter groups and too many associations all jockeying for position – and this serves to fracture our beloved profession, making us weak and vulnerable. We then become the “low hanging fruit” and are bullied by the AMA and by the insurance industry. I don’t know of one other profession who has endured so many abuses at the hands of other professions as chiropractic. But they aren’t to blame my friends. WE are. We’ve allowed ourselves to be weak. And just like the kid who gets picked on in the playground, we need to get smart and get organized so we can deal with the bullies.
I propose that what we need is to have sweeping change with regard to our accreditation in our schools. The standards must be raised. And we need to have ONE organization representing all of us. We don’t need the ACA, the ICA and the WCA. We need to have one group represent each of us. Just like how the American Physical Therapy Association (APTA) represents all physical therapists. That’s how they’re so strong politically.
The schools need to change. It’s the schools (certain ones anyway) which plant the seeds of fringe thinking and radicalism (which then manifests into certain people in our profession seeking out splinter groups. We need a standard in what we teach the students. I think the schools also need to drastically limit class sizes. Just like what the APTA does, in limiting admissions for incoming PT students. This restricts the number of people entering the profession and protects it from being oversaturated (thus protecting jobs and keeping salaries high). Palmer doesn’t think like that. All they care about are their own interests. They’ll churn out 1,000 new freshly minted D.C.’s per trimester if they could. Same with Life, Logan and all the other schools.
That’s my opinion…I could be wrong.
the wellness angle regarding patient/client care is an area we should dominate. with the soaring cost of health care insurance the need for education and self-responsibility will be even more important. our current health care reimbursement system and health care system is inefficient at best. the current model will and needs to change to more prevention. the going without care and lack of education/personal responsibilty is costing everyone billions. chiropractic is an ideal choice for this position.
Karl,
Agreed 100% with your post. I believe more chiropractors will try to incorporate the wellness model into their practices to a much greater extent once they figure out a way to profit from it. It will necessitate them to step up their patient education efforts and also to create a workable and affordable program for the patients.
The wellness practice is my dream set up. I’d much rather have 400-500 existing patients coming to me twice a month for a maintenance adjustment than to have to continuously market for new acute care patients.
Kevin
he whole catch-22 for chiropractors has to change. what i’m speaking of is the linguistics of maintenance. the health care insurance industry wants to put people in a category i get that. but the notion that if you receive chiropractic care without symptoms as pre-existing and/or care not needed is not fair. the physical therapy profession has a relationship with some people as “clients” vs. “patients”. the health care insurance acturacies don’t want us to fix something until it’s broken. i think as chiropractors to educate people about the importance of movement on all levels whole body and regional but more importantly optimizing the nervous system.
the cost to fix it after being broken is more expensive now than ever. spending the money over time i feel will be in vogue on a bigger scale. i would be interested in hearing what people think about this “client” vs. “patient” strategy.
Although there’s not a lot of papers that have focused on “maintenance” care and it’s clinical outcomes, Dr. Ron Rupert published a two part series in JMPT that reported that older patients who received maintenance care experienced a “a 50% reduction in medical provider visits” and that the cost of health care for patients receiving MC in this study was far less than that for patients of similar age in the general population, despite the doubling of physician visits (medical plus chiropractic).
The Wellness and Chiropractic Page will continue to collect these types of studies as they become available.
Great research article! It is interesting to note that whether you are speaking wellness or therapeutically oriented care, chiropractic comes out ahead. Unfortunately chiropractors cannot have the best of both worlds in the chiropractic billing scenario — insurance coverage for wellness is just not there yet.
Great article and thanks for all your input. We are splintered and like Dr. Smith stated tomorrow we could have a whole new off shoot of the newest of Chiropractors doing something totally different. Ted Koren (KST) is a great example. He developed his own technique, marketed it, and now anyone can use it whether they are a Chiropractor or not. Infact, you don’t even need to be a Chiropractor to attend his seminar and get certified. Now, I am only talking about technique specific issues, I am talking about walking into any chiropractor in any state, and you will never get the same thing twice.