CHIROPRACTOR-DIRECTED COSTS MORE THAN WHEN PHYSICAL MEDICINE CARE IS MANAGED BY PHYSICIANS, SAYS WCRI STUDY

CHIROPRACTIC CARE COULD ACHIEVE LOWER COSTS 
BY LIMITING VISITS

CAMBRIDGE, MA, January 23, 2003 – The costs of treating back strains and sprains for injured workers with physical medicine services, such as manipulations, exercise, hot and cold packs and massage are greater when the care is directed by chiropractors than when it is managed by physicians, according to a new study by the Workers Compensation Research Institute (WCRI).

Importantly, the study also found that chiropractic care could achieve the same outcome at lower costs if the number of visits were limited.

The study reported that chiropractor-directed physical medicine care costs 30 percent more than physician-directed care and achieved the same outcomes as measured by duration of temporary disability.

The higher number of visits that chiropractors use per case is the major driver behind the higher physical medicine payments, according to the Cambridge, Mass.-based WCRI.  However, the study also found that chiropractic care achieved the same outcome at lower cost than physician-directed physical medicine care in Florida where reimbursement rules place strict limits on the number of chiropractic visits per case that will be reimbursed by workers’ compensation payors.

The study, Patterns and Costs of Physical Medicine:  Comparison of Chiropractic and Physician-Directed Care, analyzed 28,539 workers’ compensation cases involving back strains and sprains in five states: California, Connecticut, Florida, Massachusetts and Texas.

“Physical medicine services are an important component of workers’ compensation costs, representing about 20 percent of total medical costs in state workers’ compensation systems,” said Dr. Richard Victor, executive director of  WCRI and the study’s lead author.  “Learning more about how these services are delivered and how their costs differ can help improve outcomes to injured workers and also lower overall system costs.”

In particular, he observed, the study’s finding that there are significant differences in costs between physician-delivered physical medicine services and chiropractor-delivered care deserves further exploration. “The fact that treatment and billing practices by Florida chiropractors result in lower medical costs while achieving a similar duration of disability as physician-directed care may provide lessons that other states can draw from.”

The study found that physical medicine services are most often used for back injuries, representing 41 percent of all injuries that receive such services.  This is not a surprising finding as back injuries – mostly strains and sprains – represent one-quarter of all workers’ compensation injuries, so they are disproportionately more likely to receive physical medicine services.

In most cases, the study said, physicians manage care and arrange for physical medicine, either within or outside their organizations.  Chiropractors are involved in about 13 percent of the cases, two-thirds of which are under the exclusive care of chiropractors.

The study noted that the average payment per workers’ compensation claim was 30 percent higher in chiropractor-treated cases in California, Connecticut and Texas to achieve the same duration of disability as they are in physician-directed care.

That’s because chiropractor-treated claims involve more than double the number of visits, although the payment per visit is 19 percent to 24 percent lower.

On average, chiropractors use 137 percent to 158 percent more visits that provide physical medicine services and 74 percent to 90 percent more visits for which office visits are billed, according to the study.

By contrast, in Florida, chiropractor- treated claims are ten percent less expensive than similar physician-treated claims to achieve the same duration of disability.  Medical costs per claim are 14 percent lower to achieve the same outcome. 

Florida chiropractors appear to treat and bill differently from chiropractors in other states. For example, Florida chiropractors treat with an average of eight visits per claim for claims with more than seven days of lost time from the job.  Chiropractors in the other study states treat these cases with an average of 14 to 35 visits per claim.

Florida chiropractors are less likely to bill for office visit codes, and when they do, they bill for fewer visits, according to the study.

Part of the reason for the different results is that Florida law mandates absolute limits on the number of chiropractic visits per case – the lesser of 18 visits or eight weeks of treatment.

Cases treated exclusively by chiropractors have much longer durations of physical medicine services, according to the study. Nearly one-quarter have durations of 15 weeks or more. Only 35 percent have durations of 4 weeks or less.

The shortest durations of physical medicine treatment involve cases in which physicians manage treatment. In these cases, physical medicine services are either provided internally, externally by physical therapists or through hospital providers. Between one-half and three-quarters receive two weeks or less of services and more than three-quarters receive four weeks or less. About five percent have durations of physical medicine services of 15 weeks or more.

Cases treated by both chiropractors and physicians, either sequentially or concurrently, have the longest durations of treatment with 43 percent having durations of 15 weeks or more.

The Workers Compensation Research Institute (WCRI) is a nonpartisan not-for-profit membership organization conducting public policy research on workers’ compensation, health care and disability issues. Its members include employers, insurers and governmental entities, insurance regulators and state regulatory agencies, as well as several state labor organizations.