Medicare

Beyond Spinal Manipulation: Should Medicare Expand Coverage for Chiropractic Services?

By Frank M. Painter|January 12, 2015|Expanded Practice, Medicare|

Beyond Spinal Manipulation: Should Medicare Expand Coverage for Chiropractic Services? A Review and Commentary on the Challenges for Policy Makers

SOURCE: Journal of Chiropractic Humanities 2013 (Aug 28); 20 (1): 9–18

James M. Whedon, DC, MS, Christine M. Goertz, DC, PhD,
Jon D. Lurie, MD, MS, and William B. Stason, MD, MSc

The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St, Lebanon, NH 03756, USA.
james.m.whedon@dartmouth.edu

OBJECTIVES: Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions:

(1) What are the barriers to expand coverage for chiropractic services?
(2) What could potentially be done to address these issues?
(3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services?

METHODS: A literature search was conducted of Google and PubMed for peer-reviewed articles and US government reports relevant to the provision of chiropractic care under Medicare. We reviewed relevant articles and reports to identify key issues concerning the expansion of coverage for chiropractic under Medicare, including identification of barriers and rationale for expanded coverage.

RESULTS: The literature search yielded 29 peer-reviewed articles and 7 federal government reports. Our review of these documents revealed 3 key barriers to full coverage of chiropractic services under Medicare: inadequate documentation of chiropractic claims, possible provision of unnecessary preventive care services, and the uncertain costs of expanded coverage. Our recommendations to address these barriers include the following: individual chiropractic physicians, as well as state and national chiropractic organizations, should continue to strengthen efforts to improve claims and documentation practices; and additional rigorous efficacy/effectiveness research and clinical studies for chiropractic services need to be performed. Research of chiropractic services should target the triple aim of high-quality care, affordability, and improved health.

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Chiropractic Use in the Medicare Population

By Frank M. Painter|November 9, 2014|Medicare, Patient Satisfaction|

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2014 (Oct); 37 (8): 542-551 ~ FULL TEXT

Paula A.M. Weigel, PhD, Jason M. Hockenberry, PhD,
Fredric D. Wolinsky, PhD

Research Associate,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa, Iowa City, IA.
Paula-Weigel@uiowa.edu

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

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Joint Assessment – P.A.R.T.S.

By Frank M. Painter|July 15, 2014|Diagnosis, Medical Necessity, Medicare|

Joint Assessment – P.A.R.T.S.

The Chiro.Org Blog

SOURCE: Topics in Clinical Chiropractic 2000; 7 (3): 1–10

Thomas F. Bergmann, DC,
Bradley A. Finer, DC, DACAN

Clinical Science Division
Northwestern Health Sciences University
College of Chiropractic
Bloomington, Minnesota

Purpose: An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Literature on assessment approaches is reviewed and a discussion is presented.

Method: A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed.

Summary: Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Useful scientific data also are limited to only a few approaches. and there is a need for a more systematic assessment approach profession wide.

Key words: articular range oj motion, chiropractic, Medicare, palpation, physical examination, subluxation

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What is The Chiropractic Subluxation? Page

From the FULL TEXT Article

Background

Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion. The role of this assessment process in the chiropractic office is to determine whether the patient should receive chiropractic care only, chiropractic care in concert with other forms of health care, or a referral to another health care professional for some other form of stand-alone management such as acute, crisis care. This article suggests the need for, and possible form of, a standardized assessment procedure for use by chiropractic clinicians.

INTRODUCTION

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The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

By Frank M. Painter|April 29, 2014|Low Back Pain, Medicare|

The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (3): 143–154

Paula A Weigel, Jason Hockenberry, PhD,
Suzanne E. Bentler, PhD, Fredric D. Wolinsky, PhD

Candidate for PhD,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa,
Iowa City, IA.

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants’ Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

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Our No. 1 Medicare Documentation Error

By Frank M. Painter|January 18, 2014|Documentation, Medicare|

Our No. 1 Medicare Documentation Error

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic ~ January 15, 2014

By Susan McClelland

We have all heard that chiropractic documentation is being reviewed by multiple Medicare contractors and that we are failing these reviews miserably. So, where are we going wrong? In this and subsequent articles, let’s address the top reasons we are failing review, starting with the No. 1 reason – our treatment plan documentation.

Medicare regulations require that we create a treatment plan when treating Medicare beneficiaries.

This treatment plan must include three elements or it will fail review:

1) recommended level of care
(duration and frequency of visits);

2) specific treatment goals;

3) objective measures to evaluate treatment effectiveness.

To repeat, the treatment plan must include all three of these elements or it will fail review.

Unfortunately, many doctors of chiropractic are not creating treatment plans at all. For those who do, the plans generally include the recommended level of care (e.g., “Two times a week for two weeks followed by once a week for two weeks. To be re-evaluated for further care at that time”). We generally fall short when it comes to the second and third elements.

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Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B

By Frank M. Painter|June 19, 2013|Cost-Effectiveness, Medicare|

Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B

The Chiro.Org Blog

SOURCE: Spine J. 2013 (Nov); 13 (11): 1449–1454

Whedon JM, Song Y, Davis MA.

The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St,
Lebanon, NH 03756
james.m.whedon@dartmouth.edu.

BACKGROUND CONTEXT: Concern about improper payments to chiropractic physicians prompted the US Department of Health and Human Services to describe chiropractic services as a “significant vulnerability” for Medicare, but little is known about trends in the use and cost of chiropractic spinal manipulation provided under Medicare.

PURPOSE: To quantify the volume and cost of chiropractic spinal manipulation services for older adults under Medicare Part B and identify longitudinal trends.

STUDY DESIGN/SETTING: Serial cross-sectional design for retrospective analysis of administrative data.

PATIENT SAMPLE: Annualized nationally representative samples of 5.0 to 5.4 million beneficiaries.

OUTCOME MEASURES: Chiropractic users, allowed services, allowed charges, and payments.

METHODS: Descriptive statistics were generated by analysis of Medicare administrative data on chiropractic spinal manipulation provided in the United States from 2002 to 2008. A 20% nationally representative sample of allowed Medicare Part B fee-for-service claims was merged, based on beneficiary identifier, with patient demographic data. The data sample was restricted to adults aged 65 to 99 years, and duplicate claims were excluded. Annualized estimates of outcome measures were extrapolated, per beneficiary and per user rates were estimated, and volumes were stratified by current procedural terminology code.

You may also want to refer to our:

Cost-Effectiveness of Chiropractic Page

and our

Medicare Information Page

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