Chiropractic – Better Care and Cost Savings

April 16, 2018 by  

I agree with the Arizona Association of Chiropractic when they write: 

Chiropractic is the optimal, non-pharma treatment option for chronic pain patients with neuro-musculoskeletal disorders. If the state of Arizona intends to manage the healthcare costs and treatment of chronic pain and opioid use disorder patients effectively, chiropractic coverage should be extended to Arizona’s 1.7 million adults on Medicaid.  That’s why I sponsored SB 1086 this year.  Here’s the background:

Multiple states (approximately 27) currently cover the adult chiropractic population under their Medicaid programs, yet, chiropractic services are not covered by the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program, for adults over the age of 21. (Note that services are already covered under federal law for Arizona Medicaid patients under 21 years of age.)

Chiropractic care is recommended by the Centers for Disease Control as well as the Association of Attorneys General and the American College of Physicians as an effective ‘non-pharma’ alternative for effective management of chronic pain (see ‘Facts & Figures’). Multiple studies have confirmed that Medicaid chronic pain patients under the care of a chiropractor have fewer emergency room visits, primary care physician visits and fewer painkiller prescriptions filled (including opioid) compared to their non-chiropractic patient counterparts (figures included below in ‘Facts & Figures’).

Facts & Figures:

· The Centers for Disease Control (CDC) conducted reviews and produced findings on opioid use for chronic pain in March of 20161. That study concluded the following:

o If opioids are used, they should be combined with non-pharmacological therapy and no opioid pharmacologic therapy.

o “Multimodal and multidisciplinary therapies (e.g. therapies that combine exercise and related therapies with psychologically based approaches) can help reduce pain and improve function more effectively than single modalities.”

o After an 8-day prescription, 13.5% of patients were still using the opioid drugs a year later. Among those with a 30-day prescription, the rate climbed to 30% of patients still using opioids a year later.

· 27 states have chiropractic care covered in state statute in some capacity, the two most recent states to adopt full scope chiropractic cover of their AHCCCS equivalent are Rhode Island and Oregon.

· The American College of Physicians2 recommends, “for patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic treatment…[including] spinal manipulation”

· AMI (Advanced Medicine Integration Group, L.P.)3 conducted an Integrated Chronic Pain Program (ICPP) after Rhode Island adopted the full chiropractic scope to their state Medicaid programs. AMI found through an integrated interdisciplinary program for chronic pain (including chiropractic) that in this population compared to a control population:

· Total per patient costs were reduced by 36%

· Opioid use was reduced by 87%

· Total prescriptions were reduced by 72%

· ER visits were reduced by 47%

· Inpatient admissions were reduced by 38%

· Patient (self-reported) pain levels were reduced by 42%

· Optum Insurance produced a study (“Innovations in Conservative Care: Getting to the Right Provider First”)4 which concludes:

· Neuro-musculoskeletal expenses are the single largest category (17%) of medical expenses

· “Spinal complaints are the primary driver of musculoskeletal costs.”

· Non-surgical spinal care is relatively inexpensive on a per episode basis

· If manipulation is not provided during a spinal episode, it appears to lead to higher total costs per spinal episode.

Cost:

Fiscal Year 2019 will likely require an appropriation to fund chiropractic services for Arizona’s adult Medicaid population to cover the general fund contribution as well as a first year coverage of the hospital assessment.

From our calculations, we believe that appropriation will be approximately $1.95 million in its first year; subsequent to that first year, we believe that offering a non-pharma alternative with primary care physician referral will keep the utilization at a reasonable level as experienced in other states.

Essentially, we believe that after an initial implementation period, this program will see the same significant cost savings realized in other states that cover adult chiropractic.

Better care and cost savings. What’s not to like?

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