After reviewing the Report to Congress on the Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare [inhalation], I don’t have the warm and fuzzy feeling others are reporting. In particular, the cover letter, dated January 14, 2010, sent with the report to both Joe Biden (Senate) and Nancy Pelosi (House) from HHS Secretary Kathleen Sebelius, made almost no mention of the hugely positive patient satisfaction findings other chiropractic organizations are highlighting.
The cover letter did report, however, that the chiropractic demonstration project actually increased cost to Medicare and was not budget neutral, something all chiropractors were hoping for. Meaning, the extra money spent on expanded chiropractic services was not paid for by a savings in other areas. It would have been nice to finally say, once and for all, chiropractic care saves Medicare money, however, we can not…yet.
In the age of health reform and deficit talk, I’m afraid no one on capitol hill is going to look beyond the following: “Overall, the demonstration led to higher total Medicare reimbursements for services provided for NMS diagnoses, indicating that expenditure for expanded chiropractic services were not offset by Part A or Part B savings.”
Yes, it is true the report also says further analysis is warranted and potential savings do still exist, however, I think the happiness of chiropractic patients, as demonstrated by the report, will be greatly overshadowed by dollars and cents if/when congress takes on the chiropractic expansion issue.
{ 7 comments… read them below or add one }
I believe we’re fighting the issue of validity in Chiropractic with an invalid Brand. The Chiropractic industry hasn’t positioned itself or it’s Brand to demand acceptance. We’ve been sitting back and “saying” we save medicare money and our 7% of the population is satisfied. Guess what, they’re not hearing us.
We need to take a stand once and for all. We need to fix the Brand of Chiropractic to become a strong relevant profession.
Chiropractic may have cost Medicare money but how did it compare to other choices? Is the report available anywhere to see?
Hi Eugene Chiro,
A link to the report is at the top of this post, 25 page document.
Ok, This is the OIG, office of inspector general. According to a reliable source, the OIG had to be sued to provide the “full” report but was unable to determine why the 10% of the $50million used for the Medicare project was so inexpensive but only 90% of the regional billing from around the Chicago area consumed almost all of the $50million. I seriously doubt the validity of this report! There were not that many DCs in that vicinity to account for that revenue?! It would mean that there are instant millionaires in that region which I just can’t see. Furthermore, the reduction in MRI’s, meds, and other costs was not analyzed. The reduction in hospitlizations was not “added” onto the value. This study doesn’t make much sense to me. From what I have read the OIG doesn’t like chiropractic and it’s apparent. I think the freedom of information act needs to explain how it’s NOT cost effective after so many smaller studies have demonstrated that it is.
If a DC can prevent the over utilization of MRI’s which cost $800 to $1,200 and have cheaper reimbursements for x-rays that needs to be added in. That’s comparing like with like!!!!!!
Just to be accurate, no one has been sued and this is not OIG. This is a demonstration project, funded by Congress/HHS and run by CMS. The analysis was done by Brandeis University. All that has been released is an “executive summary” type of report (25 pages). The “true” report will be hundreds of pages and has not yet been released. Final conclusions cannot be drawn, IMHO, until we see that report.
Just to comment on Susan’s remarks. The Discrepancy in this study from Illinois is significantly higher than should be allowed indicating data is well above several standard deviations. My colleague requested the data from the HHS regarding this. It just didn’t make sense. So why didn’t he authors make clear note not just mention it. The data could be excluded because it is so different.
This is what my colleague has been upset he has not seen the Illinois data.
But everytime I look at this study I am frustrated. It Doesnt compare DC to MD. Why is this upsetting I just went to a UC Davis spine symposium where one of rhe topics was titltled “MRI’s use s a modality”. MDs are requesting MRIs at a rate that is over 10:1 chiropractically.
At 2 MRI s is $4000 in my area!
So to comment again I don’t think the authors clearly defined logical measures and clear analysis. Why would DC care be cheaper if it’s not being clearly measured?!
By the if Susan has rhe data from illinos my colleague would love to have it.
I think the report to congress is HUGE for chiropractic however misses the boat with respect to the bottom line.
1. Chiropractic was shown to be much more effective for treatment of back pain, neck pain, hip pain and shoulder pain.
2. Although the expanded allowance of chiropractic increased medicare costs overall, the report missed the boat completely by not figuring the cost savings to medicare by eliminating visits to MDs & DOs for pain pills, pain injections, combinations of pain pills & pain injections and surgery.
If you figure that 60% of those were extremely satisfied with their results through chiropractic vs 11% through medicine/surgery, then eliminate treatment with medicine and surgery, figure the cost savings and you’ll see how much more cost effective chiropractic is as well.
However as one commenter above points out, we do have an identity crisis in this country and we need to better brand ourselves and market ourselves to bring this valuable info to the forefront of the medical community and the media.
I know I’ll be using this info the next time I have lunch with my MD physicians friends.