Work Comp Study: Chiropractic Less Expensive, More Effective
Than Medical Care
by Michael Devitt, senior associate editor Dynamic
ChiropracticA review of more than 43,000 claims of injured
workers in North Carolina over a 19-year period has found
drastic differences in the average cost of treatment, number of
days spent in a hospital for care, and compensation payments
among patients treated by doctors of chiropractic, medical
doctors, or a combination of providers. Among other things, the
analysis revealed that, on average, the cost of treating an
injured worker was almost $2,900 less if the worker was cared
for by a doctor of chiropractic than if treatment was provided
by a medical doctor, and that injured workers treated by
chiropractors were able to return to work almost six times as
fast as patients who sought an MD for care. According to the
authors of the review, which appeared in the September issue of
the Journal of Manipulative and Physiological Therapeutics,
increasing utilization of chiropractors could result in
"substantial savings" in the state's workers' compensation
system - a finding that, if implemented nationally, could
significantly reduce the costs of treating injured workers in
the U.S.
The investigators initially examined more than 96,000 closed
injury claims for injured workers in North Carolina that
occurred between 1975 and 1994. To be included in the review,
each claim had to contain information on the nature of the
worker's injury and the part of the body injured, along with
several cost variables. After excluding records that didn't meet
the selection criteria, the authors were left with 43,650
claims, which were then categorized based upon whether the
worker used the services of medical doctors only; used the
services of only doctors of chiropractic; used both medical
doctors and chiropractors; or used neither MDs nor DCs for care.
Of the remaining claims, an overwhelming 85.4 percent
(37,290) were managed by a medical doctor. Only 0.8 percent of
the injured workers saw a chiropractor exclusively; the
remainder were seen by both MDs and DCs, or were treated in a
hospital setting. The total costs of care, including medical
costs and compensation paid to patients, totaled approximately
$1.1 billion; 7.6 million total cumulative workdays were lost
due to injury or disability. The most common type of injury
presented to providers involved the lower back, followed by
injuries affecting multiple body parts.
The authors found dramatic differences in average treatment
costs between chiropractic patients, medical patients, and
patients treated by both types of providers. For patients
treated by MDs, the average cost of treatment was $3,519 for
patient. For patients treated by both MDs and DCs, the average
cumulative costs were $5,173. For chiropractic patients,
however, average treatment costs were only $663 - roughly 18
percent of the cost of medical care, and 13 percent of the cost
of combined care.
Similar differences were seen for the entire spectrum of
variables used in the analysis. Injured workers treated by
chiropractors, for instance, experienced "temporary total
disability" (i.e., lost workdays) for an average of 33 days -
143 days less than workers seeing a medical doctor, and
more than 200 days less than workers treated by both medical
doctors and chiropractors. Hospital inpatient and outpatient
care costs for medical patients were $1,995 and $2,161 more per
worker, respectively, than for chiropractic patients. And the
average total cost of an injured worker's claim managed by a
medical doctor was $25,848 - a whopping $21,774 more than
claims managed by a doctor of chiropractic.
Claims, Lost
Workdays, and Average Costs Based on Provider
Utilization |
Variable |
MD/DC |
MD Only |
DC Only |
Number of claims |
2,155 |
37,290 |
370 |
Lost workdays per patient
(mean) |
240 |
176 |
33 |
Treatment costs per
patient |
$5,173 |
$3,519 |
$663 |
Hospital inpatient care
costs |
$2,920 |
$2,438 |
$43 |
Hospital outpatient care
costs |
$2,401 |
$2,217 |
$51 |
Total medical costs |
$10,494 |
$8,175 |
$756 |
Compensation |
$23,106 |
$17,673 |
$3,318 |
Total cost of claims |
$33,600 |
$25,848 |
$4,074 |
Lumbar/Lumbosacral
Sprains: Claims, Lost Workdays, and Average Costs Based
on Provider Utilization |
Variable |
MD/DC |
MD Only |
DC Only |
Number of claims |
958 |
9,073 |
181 |
Lost workdays per patient
(mean) |
223 |
175 |
25 |
Treatment costs per
patient |
$4,864 |
$3,425 |
$634 |
Hospital inpatient care
costs |
$2,845 |
$2,312 |
$0 |
Hospital outpatient care
costs |
$2,141 |
$2,006 |
$50 |
Total medical costs |
$9,850 |
$7,743 |
$685 |
Compensation |
$19,596 |
$15,819 |
$1,912 |
Total cost of claims |
$29,446 |
$23,562 |
$2,597 |
Chiropractic care appeared to be just as - if not more -
cost-effective when the analysis was restricted to claims
involving injuries of the lower back, such as lumbar or
lumbosacral strains. Patients in this category who were treated
exclusively by doctors of chiropractic experienced an average of
25 lost workdays (compared to 175 days for medical patients and
223 for combined care patients) and average total medical costs
of $685 (versus $7,743 for medical patients and $9,850 for
patients treated by MDs and DCs). In addition, the average total
cost of a claim for a chiropractic patient with a low back
injury was only $2,597. For medical patients, the average was
$23,562 (9.07 times more expensive); for patients receiving
combined care, the average cost was $29,446 (11.34 times more
expensive).
The authors illuminated several potential limitations within
the study that could have affected their findings. For instance,
in addition to the original set of 96,000 claims, another 52,997
were not included in the analysis because they contained only
compensation payments, and the type of provider delivering care
had been purged from the records. In addition, the investigators
were unable to determine which group of providers treated the
more severe or chronic musculoskeletal injuries. "If inpatient
and outpatient hospitals costs are an indicator," they surmised,
"then the MDs would seem to have treated the more severe and,
hence, the more costly injuries." They suggested that a more
comprehensive analysis of the claim files be conducted to attain
additional information.
The authors also noted that the number of patients utilizing
a doctor of chiropractic for care was unusually low, given that
there are no legal restrictions to injured workers who wish to
see a DC, and that the state's medical fee schedule allows for
full scope-of-practice reimbursement for chiropractors. Previous
surveys have shown that the percentage of people in North
Carolina who see chiropractors for treatment of low back pain
may range from 3 percent to 13 percent. "Comparing these rates
with the 0.8% utilization rates of chiropractors in our North
Carolina data may suggest that barriers to injured worker access
to chiropractors exist in North Carolina," they wrote.
These limitations notwithstanding, the results of the
analysis suggest that having more injured workers see a doctor
of chiropractic for care, rather than a medical doctor, could
result in "substantial savings" in workers' compensation costs
in North Carolina, with the potential to generate even more
savings if utilization of chiropractors increased on a national
scale. As noted by the authors in their conclusion:
"The differences in provider management costs, independent of
critical issues such as severity and comorbidity suggested by
these results indicate lower treatment costs, fewer lost
workdays, reduced utilization of ancillary medical services, and
reduced compensation payments for patients treated by DCs.
Recognizing the study limitations, if indeed the provider
subsets are comparable, it seems likely that substantial savings
to the workers' compensation would be possible if chiropractic
services were increased in North Carolina."
Reference
- Phelan SP, Armstrong RC, Knox DG, et al. An evaluation
of medical and chiropractic provider utilization and costs:
treating injured workers in North Carolina. Journal of
Manipulative and Physiological Therapeutics, Sept.
2004;27:442-8.
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