Tracking Low Back Problems in a Major Self-Insured Workforce:

Toward Improvement in the Patient’s Journey

The Chiro.Org Blog

SOURCE:   J Occup Environ Med. 2014 (Jun);   56 (6):   604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)

This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments.

Make sure to read their full article!

The study had four objectives:

  1. Identify all active employees reporting a back problem diagnosis during the study period.
  2. Define and classify their initial patterns of medical care and use of Rx medication.
  3. Track the effect of these patterns on direct and indirect cost outcomes.
  4. Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

  1. Information and Advice (“TalkInfo”):
    information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
    but no other procedures.
    (59 percent of employees).
  2. Complex Medical Management (Complex MM):
    physician visits for nerve blocks, surgeries, or comparable procedures
    (2 percent of employees).
  3. Chiropractic (Chiro):
    more than one visit to a DC.
    (11 percent of employees)
  4. Physical therapy (PT):
    more than one visit to a PT.
    (11 percent of employees)
  5. “Dabble”:
    episodes with at most one visit for physician, chiropractic, or PT care,
    or at most one visit to two or more of these categories.
    (17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

Approach Total Cost
Medical Management $28,231.50
Physical therapy $17,193.92
Dabble: $12,228.67
TalkInfo: $11,063.41
Chiropractic $6,983.82

Low Back/Nonneuro (three-year total)

Read the rest of this Full Text article now!