An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."1 The analysis relied on data from U.S. Medicare claims and the NPI file to determine the location of the estimated 75,000 participating DCs as they relate to the location of PCPs.
At an annual expense of more than $85 billion a year, back and neck pain are independently each among the top five ailments in the U.S. in terms of expenditure, exceeding diabetes and many others. In 2011, Medicare spending for chiropractic increased to $700 million from $466 million in 2006. The investigators focused on three areas:
- The relationship between supply of chiropractors versus supply of primary care physicians
- The potential association between supply of chiropractic care and number of visits to PCPs for neck and/or back pain
- How chiropractic care impacts national spending for PCP visits
The authors questioned "if these 2 services are substitutable (specifically, if chiropractic care absorbs visits that would otherwise be made to local PCPs for back and/or neck pain) ... however, elimination of Medicare's chiropractic care benefit may shift those visits to primary care, with questionable costs savings. Moreover, this would add strain to an already overextended PCP workforce."
The study found that the "supply of chiropractic care was positively correlated with the supply of PCP services" with "a stronger correlation between the supply of chiropractic care with family medicine than with internal medicine." Obviously, there a fewer DCs per capita than medical PCPs: 3.1-54.7 DCs per 10,000 capita versus 18.9-239.1 PCPs per 10,000 capita.
The study also found an inverse relationship between the supply of DCs and the number of back / neck pain visits to medical PCPs: "The highest quintile of chiropractic care supply versus the lowest quintile was associated with 8% fewer visits to PCPs for back and/or neck pain. ... Residing in the highest quintile of chiropractic care supply, compared with the lowest quintile, was associated with a reduction of 15% and 10% in the number of visits for back and/or neck pain to family medicine and internal medicine physicians, respectively."
Based on this model, the authors extrapolated that "chiropractic care is associated with a reduction of 0.37 million visits to PCPs for back and/or neck pain at a total cost of $83.5 million." They also noted that "<10% of chiropractic users also use other medical services for the same episode of care" and that "there is some evidence that individuals become accustomed to seeking chiropractic care, possibly because of lower satisfaction with medical care." Another important point they made: "This estimate does not account for any potential effects on other medical services such as specialty care or diagnostic imaging."
This study demonstrates that chiropractic care reduces the use of medical care for Medicare patients. It also helps our profession recognize the need to have sufficient numbers of DCs serving the population. Clearly, 3.1 DCs per 10,000 capita is far too few.
We already know we reduce the need for more expensive medical care. Our challenge is to help medical providers, payers and the public recognize chiropractic as the lower-cost, higher-satisfaction, more effective solution for back and neck pain. That remains our responsibility.
- Davis MA, et al. Regional supply of chiropractic care and visits to primary care physicians for back and neck pain. J Am Board Fam Med, July-Aug 2015;28(4):481-490. Full text available.
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