Data could prompt comp industry to reconsider chiropractors

The average medical cost-per-claim for injured workers with lower back pain who were treated exclusively by a chiropractor was 61% less than for those who received no chiropractic treatment, according to a new report.

Experts say such data may prompt the workers compensation industry to rethink chiropractic care for injured workers, a trend that lags in some parts of the country.

The report, released May 17 by the Cambridge, Massachusetts-based Workers Compensation Research Institute, also found that lost-wage indemnity costs and temporary disability were significantly lower for workers whose lower back pain was treated by a chiropractor only: $492 in indemnity compared with $3,604 for workers who received no chiropractic treatment, and 0.7 weeks of temporary disability compared with 4.9 weeks.

Melissa Burke, Southington, Connecticut-based vice president and head of managed care and clinical for AmTrust Financial Services Inc., said the study was “enlightening to read.”

WCRI said the data bucks studies from the 1990s that indicated chiropractic care increased medical costs.

WCRI economist and study co-author Dongchun Wang said the 1990s were marked by increases in medical costs overall, which led states to clamp down on physical medicine.

Legislators and policymakers made regulatory changes to curb spending, Ms. Wang said, adding that there were “policy reforms at the state level that had an effect of discouraging chiropractors involved in workers comp.”

Ms. Wang’s research highlighted that chiropractic care “varied substantially” state to state, with the percentage of lower back pain claims with chiropractic care ranging from 5% to 34%.

Ms. Burke said other studies also confirmed that chiropractic care can lead to lower costs, including a 2011 study in the Journal of Occupational and Environmental Medicine.

“Why are we not seeing this care? It’s part of our guidelines. It’s part of the larger state guidelines,” she said.

What stood out in the WCRI study for Dr. Nina McIlree, Schaumburg, Illinois-based vice president medical management for Zurich North America, is that it states that the lower costs are “associated with” chiropractic care — and not that chiropractic care is the definitive reason.

Injury severity and access to chiropractic care in some states are also issues not addressed in the report, she said.

Ms. Wang confirmed the data’s limits in terms of severity. WCRI relied on claims data for the study and not physician notes on injury severity, she said.  

“In terms of access, we do feel that … policymakers and stakeholders may want to revisit chiropractic care in light of new information and in light of the chiropractic profession in itself, (which) has improved over time,” Ms. Wang said. “We are not saying (chiropractic care) is suitable for everybody.”

Reconsidering alternative care for some pain patients is a move in line with the industry’s shift away from pharmacological treatment, said Jeff Zeblut, Orlando, Florida-based vice president of clinical operations with Sedgwick Claims Management Services Inc.

“When they started to realize there was an opioid problem, chiropractic, acupuncture, massage (and) yoga were put more into mainstream medicine, and it became more acceptable in workers comp for physicians to prescribe,” he said.

Kate Farley-Agee, Plainfield, Illinois-based vice president of network product management for Coventry, an Enlyte Group company, agreed that the shift away from long-term prescribing of pain medications in workers comp is helping to open doors for chiropractors in the field.

“Ten years ago this was not a type of care that was usual in workers comp,” she said. Chiropractic care has evolved. … It’s started to be looked at as another way to manage certain injuries; lower back pain is an easy one. And there are other types of soft tissue muscle injuries that could be put in that category.”

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