Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic to Offer Treatment Under Medicaid: A Critical Appraisal of Missouri Inclusion of Chiropractic Under Missouri Medicaid
SOURCE: Journal of Chiropractic Humanities 2019 (Dec 10)
John R. McGowan, PhD, Leonard Suiter, DC, FICC
Department of Accounting,
Richard A. Chaifetz School of Business,
Saint Louis University,
St. Louis, Missouri
OBJECTIVES: The objectives of this study were to critically evaluate the methodology and conclusions of the fiscal notes prepared by the state of Missouri for including doctors of chiropractic (DCs) under Missouri Medicaid and to develop a dynamic scoring model that calculates the savings if DCs were allowed to offer treatment under Missouri Medicaid.
METHODS: We used a secondary analysis to determine the cost-saving assumptions to be incorporated into a dynamic model. We reviewed the literature on efficiency and effectiveness of DC–delivered care regarding the most reliable assumptions concerning cost savings and utilization. The assumptions for percentage savings from DC–provided care and the avoidance of spinal surgeries were then combined in the dynamic scoring model to determine projected cost savings from adding DCs as covered providers under Missouri Medicaid. The actual cost of opioid abuse in Missouri was then determined as a basis to measure cost savings from adding DC care as an alternative therapy for the management of neck and low back pain.
DISCUSSION: The Missouri Health Division initially used the static scoring approach to evaluate proposals to cover DC care under Missouri Medicaid. This approach only considers added costs from a legislative change.
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