More than one-quarter of injured workers (including about half of those away from work for more than one week because of their injuries) receive physical medicine services, such as manipulations and adjustments, supervised exercise, hot and cold packs, electrostimulation and massage. These services represent about 20 percent of total medical costs in workers’ compensation and are most often used for back injuries, which represent 41 percent of all injuries that receive physical medicine services.

Any one or a combination of medical providers may deliver these services. This study focuses on the two most common provider patterns: chiropractors as the sole treating provider and physicians who provide the physical medicine services or who refer to other providers, most frequently physical therapists.

The study addresses some important policy questions. Among them are:  How do costs of similar cases compare when a chiropractor provides physical medicine care and when a physician directs physical medicine care? Which provider pattern achieves a given outcome at the lowest cost?

This report analyzes similar cases in five states (California, Connecticut, Florida, Massachusetts and Texas) and focuses on a single outcome – the duration of temporary disability. Clinical efficacy, recovery of health and functioning, speed of return to work, and satisfaction of care are other important outcomes but are not addressed in this study.

Major Findings:

• To achieve a similar outcome (duration of temporary disability), total costs per claim for chiropractor-directed physical medicine care are 30 percent higher than physician-directed physical medicine care for nonsurgical back sprains and strains in California, Connecticut and Texas. In Florida, chiropractor-directed cases achieve the same outcome at 10 percent lower costs. (See Figure A.)
• Medical costs per claim in physician-managed cases are about 25 percent lower than chiropractor-directed cases to achieve a given duration of temporary disability. Indemnity costs per indemnity claim are about 20 percent lower for physician-directed cases in two states (Connecticut and Texas) but not in the others (California, Florida and Massachusetts).
• The major driver of the difference in medical cost is payment for physical medicine services. Our analysis found that the higher physical medicine payment in chiropractor-directed care is driven by the higher number of visits per case. On average, chiropractors use 137-158 percent more visits that provide physical medicine services and 74-90 percent more visits for which office visits are billed than when physical medicine care is physician-directed.
• In Florida, chiropractor-directed cases achieve the same outcome (duration of temporary disability) at a cost that is 10 percent lower than physician-directed care. This result is achieved partly because of regulatory restrictions placed on the number of chiropractic visits or weeks of chiropractic treatment which must be reimbursed by the payor.

Patterns and Costs of Physical Medicine: Comparison of Chiropractic 
and Physician-Directed Care. Richard A. Victor and Dongchun Wang. December 2002.WC-02-07.

Copyright: WCRI