Medicare

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

By Frank M. Painter|February 9, 2025|Chiropractic Care, Medicare|

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

SOURCE: J Manipulative Physiol Ther 2021 (Mar)

James M Whedon • Scott Haldeman • Curtis L Petersen • William Schoellkopf • Todd A MacKenzie • Jon D Lurie

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM: Davis ~ J Am Board Fam Med. 2015 (Jul)

Objective: Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in the supply of clinicians who provide SM to Medicare beneficiaries.

Methods: Medicare is a US government-administered health insurance program that provides coverage primarily for older adults and people with disabilities. We used a serial cross-sectional design to examine Medicare administrative data from 2007 to 2015 for SM services identified by procedure code. We identified unique providers by National Provider Identifier and distinguished between chiropractors and other specialties by Physician Specialty Code. We calculated supply as the number of providers per 100,000 beneficiaries, stratified by geographic location and year.

Results: Of all clinicians who provide SM to Medicare beneficiaries, 97% to 98% are doctors of chiropractic. The geographic supply of doctors of chiropractic providing SM services in 2015 ranged from 20/100,000 in the District of Columbia to 260/100,000 in North Dakota. The supply of other specialists performing the same services ranged from fewer than 1/100,000 in 11 states to 8/100,000 in Colorado. Nationally, the number of Medicare-active chiropractors declined from 47 102 in 2007 to 45 543 in 2015. The count of other clinicians providing SM rose from 700 in 2007 to 1441 in 2015.

Conclusion: Chiropractors constitute the vast majority of clinicians who bill for SM services to Medicare beneficiaries. The supply of Medicare-active SM providers varies widely by state. The overall supply of SM providers under Medicare is declining, while the supply of nonchiropractors who provide SM is growing.

Keywords: Chiropractic; Manipulation, Spinal; Medicare; Musculoskeletal Manipulations.

From the FULL TEXT Article:

Introduction

Low back pain is highly prevalent in the United States, and management of it can be particularly challenging in the Medicare beneficiary population, which is older and has disabilities and frequently comorbidities. [1, 2]

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The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

By Frank M. Painter|April 13, 2023|Chiropractic Management, Low Back Pain, Medicare|

The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

The Chiro.Org Blog

SOURCE: PLoS One 2023 (Apr 12); 18 (4): e0283661

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Lobke P. De la Ruelle, Annemarie de Zoete, Cornelius Myburgh, Hella E. Brandt, Sidney M. Rubinstein

Department of Health Sciences,
Faculty of Science,
Amsterdam Movement Sciences,
Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands.

Background: Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process.

Methods: Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim.

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Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

By Frank M. Painter|April 10, 2022|Medicare|

Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2022 (Mar 26) [EPUB]

Anupama Kizhakkeveettil, PhD, Serena Bezdjian, PhD, Eric L. Hurwitz, PhD, Ian Coulter, PhD, Scott Haldeman, PhD, James M. Whedon, DC, MS et. al

Ayurveda Medicine Department,
Southern California University of Health Sciences,
Whittier, California.

Davis (J Am Board Fam Med 2015)

Objective: The objective of this study was to compare patients’ perspectives on the use of spinal manipulative therapy (SMT) compared to prescription drug therapy (PDT) with regard to health-related quality of life (HRQoL), patient beliefs, and satisfaction with treatment.

Methods: Four cohorts of Medicare beneficiaries were assembled according to previous treatment received as evidenced in claims data: SMT, PDT, and 2 crossover cohorts (where participants experienced both types of treatments). A total of 195 Medicare beneficiaries responded to the survey. Outcome measures used were a 0–to–10 numeric rating scale to measure satisfaction, the Low Back Pain Treatment Beliefs Questionnaire to measure patient beliefs, and the 12–item Short Form Health Survey to measure HRQoL.

Results: Recipients of SMT were more likely to be very satisfied with their care (84%) than recipients of PDT (50%; P = .002). The SMT cohort self-reported significantly higher HRQoL compared to the PDT cohort; mean differences in physical and mental health scores on the 12–item Short Form Health Survey were 12.85 and 9.92, respectively. The SMT cohort had a lower degree of concern regarding chiropractic care for their back pain compared to the PDT cohort’s reported concern about PDT (P = .03).

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Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

By Frank M. Painter|January 20, 2022|Initial Provider, Medicare|

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

The Chiro.Org Blog

SOURCE: BMJ Open 2021 (Sep 17); 11 (9): e053229

Ørjan Nesse Vigdal, Kjersti Storheim, Rikke Munk Killingmo, Milada Cvancarova Småstuen, and Margreth Grotle

Department of Physiotherapy,
Oslo Metropolitan University,
Oslo, Norway

Objectives: To describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist (PT) or chiropractor).

Design: Cross-sectional analysis from the Back Complaints in the Elders-Norway cohort study.

Setting: Norwegian GP, PT and chiropractic primary care centres.

Participants: Patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain were invited to participate. Between April 2015 and February 2020, we included 452 patients: 127 first visited a GP, 130 first visited a PT and 195 first visited a chiropractor.

Primary and secondary outcome measures: For the first objective, the outcome measure was descriptive statistics of patient characteristics, covering the following domains: sociodemographic, general health, current and previous back pain, psychological and clinical factors. For the second objective, first primary care provider was the outcome measure. Associations between patient characteristics and visiting a GP or PT compared with a chiropractor were assessed with multiple multinomial regression analyses.

Results: Median (IQR) age was 66 (59-72) years. Levels of back-related disability was moderate to severe, with a median (IQR) Roland-Morris Disability Questionnaire (range 0-24) score of 9 (5-13). Recurring episodes were common, 301 (67%) patients had monthly or yearly recurrences. Patients with worse back-related disability, longer duration of symptoms, lower expectations for full recovery and worse physical performance measured with the Back Performance Scale had higher odds of visiting a GP or PT compared with a chiropractor (p<0.05).

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Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

By Frank M. Painter|December 23, 2021|Cost-Effectiveness, Low Back Pain, Medicare|

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Dec 5)

James M. Whedon, DC, MSm Anupama Kizhakkeveettil, PhD, Andrew Toler, MS, Todd A. MacKenzie, PhD, Jon D. Lurie, MD, MS, Serena Bezdjian, PhD, Scott Haldeman, DC, MD, PhD, Eric Hurwitz, DC, PhD, Ian Coulter, PhD

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM: The Facts on Medicare Spending (2019)

Objectives: The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).

Methods: We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.

Results: The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).

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The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

By Frank M. Painter|May 9, 2021|Low Back Pain, Medicare|

The Profile of Older Adults Seeking Chiropractic Care: A Secondary Analysis

The Chiro.Org Blog

SOURCE: BMC Geriatrics 2021 (Apr 23); 21 (1): 271

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Katie de Luca, Sheilah Hogg-Johnson, Martha Funabashi, Silvano Mior & Simon D. French

Department of Chiropractic,
Faculty of Medicine,
Health and Human Sciences,
Macquarie University,
Sydney, Australia.

Background: Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

Methods: A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using ?2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

Results: A total of 6,781 chiropractor-adult patient encounters were recorded. Of these, 1,067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

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