Chiropractors Reduce Costs by 40% if the 1st Option for Spine
FEATURE
FINANCIAL
DC's would save the healthcare system 1.86 Trillion Dollars over 10 years.
Matt Erickson
DC, FSBT
Mark Studin
DC, FASBE(C), DAAPM, DAAMLP
Introduction
Currently, our country is facing a healthcare crisis not only with respect to the opioid epidemic but also because healthcare costs in the U.S. have skyrocketed out of control. According to a national health expense (NHE) fact sheet published by Centers for Medicare and Medicaid Services (CMS) (2017), “NHE grew 3.9% to $3.5 trillion in 2017, or $10,739 per person, and accounted for 17.9% of gross domestic product (GDP).” CMS (2017) also predicted, “Under current law, national health spending is projected to grow at an average rate of 5.5% per year for 2018-2027 and to reach nearly $6 trillion by 2027” (www. cms. gov/research-statistics-data-and-sy stems/ statistics-trends-and-reports/nationalhealthexpenddata/ nhe-f act-sheet, html).
In a study of data primarily from 2013 to 2016, Papanicolas, Woskie, and Jha (2018) reported, “The United States spends more per capita on health care than any other nation, substantially outpacing even other very high-income countries. However, despite its higher spending, the United States performs poorly in areas such as healthcare coverage and health outcomes”.(p 1025)
Papanicolas et al. (2018) also stated, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals and administrative costs, appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries” (p 1038). Papanicolas et al. (2018) reported, “Ten high-income countries were selected for comparison”. (p 1025) The 10 countries included “the United Kingdom (consisting of England, Scotland, Wales, and Northern Ireland), Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland”.(p 1025)
Singh, Andersson, and Watkins-Castillo (2019, para. 1) reported, “Lumbar/low back pain and cervical/neck pain are among the most common medical conditions requiring medical care and affecting an individual’s ability to work and manage the daily activities of life. Back pain is the most common physical condition for which patients visit their doctor. In any given year, between 12% and 14% of the United States adult population age 18 and older visit their physician with complaints of back pain. The number of physician visits has increased steadily over the years. In 2013, more than 57.1 million patients visited a physician with a complaint of back pain, compared to 50.6 million in 2010. Also, an unknown number of patients visit a chiropractor or physical therapist for these complaints. Singh et al. (2019, para. 4) further reported, “The estimated annual direct medical cost for all persons with a back-related condition in 2014 dollars was an average of $315 billion per year across the years 2012-2014” (www.boneandjointbnrden. org fourth-edition iiaOVlow-back-and-neck-pain).
According to Cynthia Cox of the Kaiser Family Foundation (2017) reporting on data from 2013, “The top five disease-based spending categories (ill-defined conditions, circulatory, musculoskeletal, respiratory, and endocrine) account for half of all medical services spending by disease category. Ill-defined conditions each represent about 13% of overall health spending by disease while circulatory, musculoskeletal, respiratory, and endocrine conditions represent 12%, 10%, 8%, and 8% respectively. That is to say, musculoskeletal disease represents 10% of the healthcare expenditures” (See figure 2) (www.healthsystemtracker.o rg/c hart-collection much-u-s-spend-treat-different-diseases/#item-top-five-disease-categoriesaccount-roughly-half-medical-servicesp ending).
Neck and back pain is one of the most prevalent issues that presents to primary care physician (PCP) offices. Considering the current opioid crisis and the associated healthcare expenditure, particularly related to neck and back pain, it raises the question of whether doctors of chiropractic, who are licensed to manage spinal disorders and have comprehensive training in spine care, can provide similar or better outcomes and greater or equivalent satisfaction among patients? In addition, can they provide care in a more cost-effective manner and help unburden the already overloaded primary care practices considering the trending shortage of PCPs in our healthcare delivery system?
Figure 2 - The top 5 diseases categories account for half of spending
Total expenditures in US$ billions, by disease category
Note: Spending on dental services, nursing homes, and prescriptions that cannot be allocated to a specific disease not included above.
Graphic courtesy of the 2017 Peterson-Kaiser report, “How much does the U.S. spend to treat different disease? ”
The Evidence
In an article by Houweling, Braga, Hausheer, Vogelsang, Peterson, and Humphreys (2015), the authors reported on first-contact care with a medical versus chiropractic provider after a consultation with a Swiss telemedicine provider. The study looked to compare outcomes, patient satisfaction and healthcare costs in spinal, hip, and shoulder pain patients.
Houweling et al. (2019) reported, “Pain of musculoskeletal origin represents a major health problem worldwide. In a Swiss survey conducted in 2007, back pain was a commonly reported health problem, with 43% of the population experiencing this complaint over the course of a year. Of these, 33% reported that their symptoms led to reduced productivity at work. The burden of musculoskeletal conditions on the Swiss healthcare system is equally staggering, with healthcare expenditure resulting from this condition being estimated at 14 billion Swiss Francs (CHF) per year (U.S. $14 billion) or 3.2% of the gross domestic product”, (p-478-479)
The study by Houweling et al. (2019) also showed that spinal, hip, and shoulder pain patients had modestly higher pain relief and satisfaction with care at lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs”. (p 480)Houweling et al. further added, “Although the differences in pain relief scores between groups were statistically significant, they were likely not of clinical significance”?15 480) Houweling et al. explained the reason for this was “the extent of the differences in pain relief observed might be too small for patients to notice a clinically meaningful difference”.(p 480)
With respect to patient satisfaction, Houweling et al. (2015) reported, “The findings of this study pertaining to patient satisfaction were in line with previous research comparing chiropractic care to medical care for back pain, which found that chiropractic patients are typically more satisfied with the services received than medical patients”. (p 481) Houweling et al. added, “The mean total spinal, hip, and shoulder pain-related healthcare costs per patient during the four-month study period were approximately 40% lower in patients initially consulting DCs compared with those initially consulting MDs. The reason for this difference was a lower use of healthcare services other than first-contact care in patients initially consulting DCs compared with those initially consulting MDs”.(p 481)
Thus, Houweling et al. (2015) concluded, “The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions”. (p 481) The authors also noted, “In addition to potentially reducing healthcare costs, direct access to chiropractic care may ease the workload on MDs, particularly in areas with poor medical coverage and hence enabling them to focus on complex cases. The minority of patients with complex health problems initially consulting a chiropractic provider would be referred to, or comanaged with, a medical provider to provide optimal care”.(p 481)
Conclusion
In conclusion, healthcare costs have skyrocketed out of control with the prediction that U.S. expenditures will reach $6 trillion by 2027. Considering neck and back pain expenditures between 2012 to 2014 averaged $315 billion annually, and total healthcare costs in 2017 were $3.5 trillion, this means approximately 10% of healthcare expenditures annually are for neck and back pain, which is supported by the Peterson-Kaiser Health Tracker System report. Moreover, considering the estimated healthcare costs are predicted to be $6 trillion by 2027, if the expenditure for neck and back pain remained on par at 10%, that means the cost of neck and back pain would increase to around $600 billion over that time.
Considering Houweling et al., using doctors of chiropractic as a first-line provider for spine, hip, and shoulder pain demonstrated a 40% reduction in costs. That means in 2027, if DCs were first-line providers, it is estimated it could save the healthcare delivery system $240 billion in one year alone (just for neck and back pain). If one considers the prediction of 5.5% annual expenditure increase, that means the estimated total expenditure for neck and back pain between 2018 to 2027 would be $4.65 trillion. If having DCs as a first-line provider were to save 40% in costs, that would translate into saving $1.86 trillion. If that was applied to the predicted 2027 neck-and-backpain expenditure, that number would represent a 32% savings in that year. Given our skyrocketing healthcare costs, that would represent a significant savings!
Further, if we consider from the study that a modestly higher pain relief and ever greater patient satisfaction was reported, when you factor in the predicted PCP shortage, the ability for DCs to serve as a first-line provider will not only help unburden the already overloaded PCPs, but also have a significant financial impact in lowering healthcare expenditures. All things considered, it is time our decision-makers take a serious look at improving access to doctors of chiropractic so they may serve as first-line providers for the management of all spine-, hip-, and shoulder-related disorders.
References
1. “National Health Expenditure Fact Sheet” (2019, April 26). Centers for Medicare and Medicaid. Retrieved from https://www.cms.gov/research-statistics-data-and-systems stcitistics-trends-and-reports ncitioncilhealthexpenddatahhe-fact-sheet.html.
2. Irene Papanicolas, Liana R. Woskie, Ashish K. Jha. (2018). Health Care Spending in the United States and Other High-Income Countries, Journal of the American Medical Association, 319(10), 1024-1039.
3. Kern Singh, MD, Gunnar Andersson, MD, PhD and Sylvia I. Watkins-Castillo, PhD. (2019) United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), forthcoming. Rosemont, IL. Retrieved from https:// www.bonecmdjointburden. org fourth-edition iiaO low-back-cmd-neck-pain.
4. Cox Cynthia. (2017, May 22). How much does the U.S. spend to treat different disease? Peterson-Kaiser Health Tracker System. Retrieved from www. healthsystemtracker.org chart-collection much-us-spend-treat-different-diseases #item-top-five-disease-categories-account-roughly-half-medical-service-spending.
5. Houweling, Braga, Hausheer, Vogelsang, Peterson and Humphreys. (2015). First-Contact Care with a Medical vs. Chiropractic Provider After Consultation with a Swell Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoidder Pain Patients. Journal of Manipulative and Physiological Therapeutics, 38(7), 477-483.
HDr. Erickson is the President of Body Right Chiropractic in Clearwater, Florida. He graduated from Hope College in 1994 with a BA in Chemistry (Biochemistry emphasis) and a Physical Education minor. Dr. Erickson graduated from Palmer College of Chiropractic in 1998 earning the President's List Award for clinical excellence. Through the Academy of Chiropractic he is Trauma Qualified, Primary Spine Care Qualified and Interprofessional Hospital Qualified. In 2018, he completed a 2-year Fellowship in Spinal Biomechanics and Trauma. You can reach Dr. Erickson at [email protected] or (727) 498-5208.
Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, is an adjunct professor of chiropractic in 3 colleges of chiropractic across the country. He teaches MRI spine interpretation, spinal biomechanical engineering, and triaging trauma cases. He is the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the medical and legal communities (www.DoctorsPIProgram. com) and teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally (www. TeachDoctors.com).
[email protected] or at 631-786-4253.
