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The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

By |December 15, 2021|Cost-Effectiveness, Cost-Effectiveness of Chiropractic|

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2021 (Aug 7)

Matthew Davis, Olga Yakusheva, Haiyin Liu, Brian Anderson, Julie Bynum

University of Michigan,
400 North Ingalls, Room 4347,
Ann Arbor, MI 48109

Objective:   The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

Methods:   We used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation. Using a difference-in-difference analysis (before versus after relocation), we compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

Results:   Among those who experienced a reduction in access to chiropractic care (versus those who did not), we observed an increase in the rate of visits to primary care physicians for spine conditions (an annual increase of 32.3 visits, 95% CI: 1.4-63.1 per 1,000) and rate of spine surgeries (an annual increase of 5.5 surgeries, 95% CI: 1.3-9.8 per 1,000). Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 beneficiaries on medical services ($391 million nationally).

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Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

By |December 14, 2021|Palpation|

Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

The Chiro.Org Blog

SOURCE:   Manual Therapy 2005 (Aug); 10 (3): 207–218

Mark Laslett, Charles N. Aprill, Barry McDonald, Sharon B. Young

Department of Health and Society,
Linköpings Universitet,
Linköping, Sweden.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard.

In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842.

In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

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CHIROPRACTIC SUBLUXATION Page and the:

SPINAL PALPATION page

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Self-management at the Core of Back Pain Care:
10 Key Points for Clinicians

By |December 13, 2021|Biopsychosocial Model, Exercise and Chiropractic, Low Back Pain|

Self-management at the Core of Back Pain Care:
10 Key Points for Clinicians

The Chiro.Org Blog

SOURCE:   Braz J Phys Ther 2021 (Jul); 25 (4): 396–406

Alice Kongsted, Inge Ris, Per Kjaer, Jan Hartvigsen

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmarkm
Odense M, Denmark;

Chiropractic Knowledge Hub,
Odense M, Denmark.

Background:   A paradigm shift away from clinician-led management of people with chronic disorders to people playing a key role in their own care has been advocated. At the same time, good health is recognised as the ability to adapt to changing life circumstances and to self-manage. Under this paradigm, successful management of persistent back pain is not mainly about clinicians diagnosing and curing patients, but rather about a partnership where clinicians help individuals live good lives despite back pain.

Objective:   In this paper, we discuss why there is a need for clinicians to engage in supporting self-management for people with persistent back pain and which actions clinicians can take to integrate self-management support in their care for people with back pain.

Discussion:   People with low back pain (LBP) self-manage their pain most of the time. Therefore, clinicians and health systems should empower them to do it well and provide knowledge and skills to make good decisions related to LBP and general health. Self-management does not mean that people are alone and without health care, rather it empowers people to know when to consult for diagnostic assessment, symptom relief, or advice. A shift in health care paradigm and clinicians’ roles is not only challenging for individual clinicians, it requires organisational support in clinical settings and health systems. Currently, there is no clear evidence showing how exactly LBP self-management is most effectively supported in clinical practice, but core elements have been identified that involve working with cognitions related to pain, behaviour change, and patient autonomy.

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The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey

By |December 8, 2021|Chiropractic Care|

The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey

The Chiro.Org Blog

SOURCE:   Spine (Phila Pa 1976) 2017 (Dec 1); 42 (23): 1810-1816

Jon Adams, Wenbo Peng, Holger Cramer, Tobias Sundberg, Craig Moore, et al.

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM),
Faculty of Health, University of Technology Sydney,
Sydney, New South Wales, Australia.



From: Use of Yoga, Meditation, and Chiropractors Among U.S. Adults

Study design: Secondary analysis of a national survey.

Objective:   The aim of this study was to investigate the prevalence, patterns, and predictors of chiropractic utilization in the US general population.
Summary of background data: Chiropractic is one of the largest manual therapy professions in the United States and internationally. Very few details have been reported about the use of chiropractic care in the United States in recent years.

Methods:   Cross-sectional data from the 2012 National Health Interview Survey (n = 34,525) were analyzed to examine the lifetime and 12-month prevalence and utilization patterns of chiropractic use, profile of chiropractic users, and health-related predictors of chiropractic consultations.

Results:   Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use among US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 63.8% reported chiropractic care combined with medical treatment as helpful. Both adults older than 30 years (compared to younger adults), and those diagnosed with spinal pain (compared to those without spinal pain) were more likely to have consulted a chiropractor in the past 12 months.

Conclusion:   A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common. Studies on the current patient integration of chiropractic and conventional health services are warranted.

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ICD-10 Guidelines and Code Changes Take Effect October 1, 2021

By |September 30, 2021|ICD-10 Coding|

ICD-10 Guidelines and Code Changes Take Effect October 1, 2021

The Chiro.Org Blog

SOURCE:   Illinois Chiropractic Society

Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

 

The World Health Organization and the Centers for Medicare and Medicaid Services have released the diagnosis code updates for the fiscal year 2022. The changes in codes and guidelines take effect on October 1, 2021, and affect all services rendered on or that date. Therefore, all offices must be aware of the changes and assess how the changes will impact your office. Ignorance or a lack of action on your part may lead to denials or recoupment.

Unlike FY 2021, there are not as many code changes this year, but the impact may still be the same in your office. 165 new codes have been implemented this year, compared to 485 codes last year.

In addition, there were updates to the ICD-10-CM Official Guidelines for Coding and Reporting. Every physician and their staff should remember that it is imperative to “code to the highest level of specificity.” Insurance carriers base their reimbursement on the codes you list on the claim form. A non-specific code yields limited information and will yield a limited amount of approved treatment. It is essential to review the guidelines and the new codes to ensure you are assigning the most appropriate codes.

Among the notable guideline changes are involving laterality. When the patient’s provider does not document laterality, code assignment for the affected side may be based on medical record documentation from other clinicians. Codes for an “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side, and it is impossible to obtain clarification. Any unspecified code is deemed a red flag in coding. Be specific.

In the past, the provider or their staff had to confirm a condition. The guidelines now state that exceptions will allow the doctor to report information gained from outside records.

These would include the following:

  • Body Mass Index (BMI)

  • Depth of non-pressure chronic ulcers

  • Pressure ulcer stage

  • Coma scale

  • NIH stroke scale (NIHSS)

  • Social determinants of health (SDOH)

  • Laterality

  • Blood alcohol level

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