Chiropractic Care May Reduce Surgeries, X-rays

Treating Back Pain Less Costly With Chiropractic Care

Oct. 12, 2004 -- Chiropractic care cuts health care costs, a new study shows.

The study comes from American Specialty Health Plans Inc. of San Diego. The company provides employers with health insurance coverage for complementary medicine, including chiropractic care and acupuncture.

The company compared four years of back pain claims from two groups: 700,000 health plan members with chiropractic care coverage and 1 million members with the same health plan without chiropractic care coverage. It's the largest study yet of how chiropractic care affects the cost of health care, notes study co-leader Douglas Metz, DC, chief health services officer at American Specialty Health.

"No matter how we perform the analysis -- whether we look at total costs to the health plan, at lower back pain care, at musculoskeletal care -- in each data set, the population covered for chiropractic had a lower overall cost to the health plan than the population without access to chiropractic benefits," Metz tells WebMD. "We believe this study is the first to show that chiropractic [care] can be a cost-effective treatment option for back pain."

Costs Down, Patient Satisfaction Up With Chiropractic Care

Compared with doctor-only health plans, the study found that:

The report appears in the Oct. 11 issue of Archives of Internal Medicine.

Although the researchers did not look at patient satisfaction in this study, Metz says company studies show that 95% of chiropractic care patients are satisfied with the care they receive.

Patients often say they are satisfied with the chiropractic care they receive, says Scott Boden, MD, director of the Emory Orthopaedic and Spine Center in Atlanta.

"Chiropractic patients tend to be satisfied because of the hands-on attention they get," Boden tells WebMD. "But there are different schools of chiropractic and different kinds of chiropractors. There are some that make accurate medial diagnoses and give appropriate treatments, and there are those that treat less well-documented disorders with treatments that may not be of acceptable quality. There is a wide range of variation."

Doctors, too, vary in the quality of care they offer back pain patients, Boden says. Patients without chiropractic care coverage may first see general practitioners who may run up health care costs by prematurely sending patients off to get expensive tests and treatments.

"A disease like back pain can have a lot of variability in the ways medical professionals approach patient care," Boden says. "The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care. Many -- if not most -- primary care providers have little training in how to manage musculoskeletal disorders. That leads to some of the costs. If you were to match a chiropractic network against trained physicians instead of general medical practitioners, you might get different results."

Chiropractic Care Entering Mainstream

This may be the first study to offer concrete evidence that chiropractic care saves money. But businesses already are getting the message, says George DeVries, president and CEO of American Specialty Health.

"Since 1987, we have thousands if not tens of thousands of employer groups that offer chiropractic coverage as a supplemental insurance rider," DeVries tells WebMD. "These range from mom-and-pop groceries to top-10 businesses. The reason they continue to offer these plans is patient satisfaction and low cost."

Boden says his institution is opening a new facility that will offer patients integrated medical care that will include chiropractic care.

"We have everything under one roof. The finishing piece is going to be a complementary medicine center that will include chiropractic, massage, acupuncture, and probably nutrition," he says.

Even so, it would be a leap of faith to say that doctors and chiropractors always agree on the best way to treat back pain.

"We screened 50% of the chiropractors in the Atlanta area before we found two who were medically appropriate and similar in approach to how we deal with spine problems," Boden says.

But Metz maintains that chiropractic care offers quality treatment of back pain.

"The bottom line is that conservative management of back care is effectively performed by doctors of chiropractic," he says. "In cases where medical intervention is needed, chiropractors are schooled to make the appropriate referrals. It is a cost-effective option for back pain."

SOURCES: Legorreta, A.P. Archives of Internal Medicine, Oct. 11, 2004; vol 164: pp 1985-1992. Douglas Metz, DC, chief health services officer, American Specialty Health Plans, San Diego. George DeVries, president and CEO, American Specialty Health Plans, San Diego. Scott Boden, MD, professor of orthopaedics, Emory University School of Medicine; director, Emory Orthopaedic and Spine Center, Atlanta.

http://my.webmd.com/content/article/95/103236.htm