The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities

Abstract

Objective The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP). Methods We conducted an observational, retrospective study of 2006–2012 Medicare fee-for-service reimbursements for 72,326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. We used propensity score weighting to address selection bias. Results After propensity score weighting, total and per-episode day Part A, Part B, and Part D Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; these patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode. Expenditures were greatest for patients receiving medical care alone; order was irrelevant when both CMT and medical treatment were provided. Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. While patients who used only CMT had the lowest Part A and Part B expenditures per episode day, we found no indication of lower psychiatric or pain medication expenditures associated with CMT. Conclusions This study found that older multiply-comorbid patients who used only CMT during their cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients in the other treatment groups. Further, costs of care for the episode and per episode day were lower for patients who used a combination of CMT and conventional medical care than for patients who did not use any CMT. These findings support initial CMT use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients

Effectiveness of chiropractic modality on chronic low back pain patients, A quasi-experimental study

“…There are limited studies that evaluated clinically meaningful effect after chiropractic modality. According to the study of Weeks et al, on elderly patients with chronic LBP who used chiropractic therapy as the rst line of treatment during LBP attack, the overall cost of treatment and the length of each attack was reduced (35). The result of current study consistent with Christine et al that showed that the addition of chiropractic care to the usual medical care can improve the disability and pain intensity reduction in LBP, without report meaningful effect.…”

Chiropractic Management of a Patient With Chronic Pain in a Federally Qualified Health Center: A Case Report

“…A study found that older patients with multiple comorbidities who used only chiropractic manipulative therapy during their chronic LBP episodes had lower overall costs of care, shorter episodes of LBP, and lower cost of care per episode day than patients in the other treatment groups, which included treatment by conventional medicine. 14 Adults with LBP are more physically and mentally unhealthy than those individuals without LBP. Murphy et al state that physical activity improves general health and halts the progression of chronic pain.…”

“…Access to chiropractic care appears to offset a patient's demand for primary care physicians' services, further reducing the number of opioid prescriptions written. 14 However, chiropractic care is often out of reach for many patients with chronic pain for monetary and accessibility reasons.…”

Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis

“…Because chiropractic has been covered by health plans for a number of years, a portion of chiropractic research has used claims data to examine the effect of going to a DC vs a conventional medical practitioner for care of musculoskeletal conditions. [25][26][27][28][29][30] These can be considered to be studies of the impact of the chiropractic profession. Nevertheless, there have been a number of efficacy studies of spinal manipulation itself.…”