Objective
A managed care organization (MCO) examined differences in allowed cost for managing low back pain by medical providers vs chiropractors in an integrated care environment. The purpose of this study is to provide a retrospective cost analysis of administrative data of chiropractic vs medical management of low back pain in a managed care setting.
Methods
All patients with a low back pain–related diagnosis presenting for health care from January 2004 to June 2004 who were insured by an MCO in northeast Wisconsin were tracked. The cumulative health care costs incurred by this MCO during the 2-year period from January 2004 to December 2005 related to these back pain diagnoses were collected.
Results
Allowed costs of chiropractic treatment were 12% greater than medical primary care and 60% less per case than other types of medical care combined, on a per-case basis: median cost of medical primary care was $365.00, chiropractic care was $417.00, and medical nonprimary care was $669.00.
Conclusion
This study of an MCO's low back pain allowed costs may be better redirected to primary care or chiropractic, given equivalent levels of case complexity. This study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.
The data are from an insurance claims database of a private health maintenance organization (HMO) plan in Northeast Wisconsin that insures approximately 30 000 individuals. The study was reviewed and granted exclusion from an institutional review board by the University of Massachusetts–Amherst School of Public Health and the HMO providing the “deidentified” database information. All providers were reimbursed by a discounted fee for service. This HMO did not restrict chiropractic management on the basis of total visits, costs, or procedures during the study duration. The study population was health plan members continuously enrolled from January 1, 2004, to December 31, 2005, and had at least one visit with a medical provider or chiropractor for a primary or secondary diagnosis of LBP and/or back-associated leg symptoms (Table 1) at some time between January 1, 2004, and June 30, 2004. A small number of patients who saw both types of providers during the initial 6-month period were excluded. The total study population included 896 members. Total direct costs allowed by the insurance company were then calculated for the 2-year period from January 2004 through December 2005. All procedures related to back pain diagnosis were included in calculation, such as imaging, hospital, physical therapy, and outpatient office charges. No data on medication costs were available, as the claims database used, as in other studies of claims data, cannot tie a diagnosis to pharmaceutical prescriptions.
The members' costs were then categorized according to those who saw either a chiropractor or medical provider (family practice, internal medicine, pediatrics, obstetrics/gynecology, physical medicine, neurology, neurosurgery, sports medicine, or orthopedics) during the initial 6-month period. The range of ages in the population was between 5 and 83 years, with an average age of 43 years.
Data files were received from the insurance company in Microsoft Excel (Microsoft Inc, Redmond, Wash) with a unique identifier assigned to patients meeting the above criteria. The files contained service dates; specialty of providers rendering service and whether they were participating providers with the network; primary and, if applicable, secondary diagnosis on the claim; procedure codes; and birth date and sex of the patient, as well as allowed amount by the insurance company. The allowed amount for each case is a good proxy for total cost per case.
In summary, this study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.
