By Sherry McAllister, DC
On which health conditions do you think our country spends the most? Diabetes, heart disease and hypertension? While these chronic conditions are costly, from 1996 through 2016, it has been musculoskeletal disorders that are the most and second-most expensive, according to a study published in March in the Journal of the American Medical Association (JAMA).
The study examined commercial, government and patient out-of-pocket healthcare spending. No conditions were as costly to payers as low back and neck pain – which are also the most common conditions treated by doctors of chiropractic (DCs) – followed by other musculoskeletal disorders.
DCs, however, are not always the first provider-of-choice to treat those disorders. For low back pain, 69% of patients choose a primary care physician instead of a DC for their first consultation. This initial visit is often more costly for the payer, but also leads down the care pathway toward pharmaceuticals, imaging tests and surgery, the latter of which is often ineffective and risky for the patient.
Instead, healthcare payers – including patients paying out of their pocket – could save significant funds and reduce the chances of long-term opioid use while patients could experience low back pain relief have improved mobility and overall quality of life by pursuing chiropractic care first compared to pharmacological and surgical care.
The elephant in the room
Low back pain is a condition that 80% of people will have at least once in their lives. Although incredibly common, it is largely an afterthought in the healthcare spending discussion. Here’s why:
- Age. The Centers for Medicare and Medicaid Services drives much of the healthcare industry’s policy discussion and decisions, and since their beneficiaries are aged 65 and over, back pain does not receive the attention it deserves as it afflicts the middle-aged population more than the elderly. In the JAMA study, nearly 68% of claims for patients with the condition were between 20 and 64 years old and only 30% were aged 65 or older. Conversely, nearly 57% of the claims studied for Ischemic heart disease and more than 51% of claims for hypertension were for patients aged 65 and older.
- Mortality. Another reason low back and neck pain isn’t discussed with the same urgency as other costly chronic conditions is, to put it bluntly, low back pain isn’t fatal. Being on the front lines of the battle against this condition, however, I have seen how low back pain destroys patients’ quality of life from the stress of constant pain to interrupted sleep to diminished enjoyment or inability to perform activities of daily living. While low back pain may not kill us, it can certainly impact our quality of life.
- Changing guidelines. The pharmacological guidelines to treat heart disease, hypertension, diabetes and other costly conditions are well-established and largely effective if followed correctly. In recent years, however, there has been a shifting consensus away from the traditional pharmacological and surgical guidelines for treating low back pain. In 2019, for example, the Bulletin of the World Health Organization reviewed six sets of updated international guidelines for managing low back pain and determined medication should not be a first-line treatment, preferring therapies such as spinal manipulation, 94% of which are performed by DCs in the U.S. The Lancet, another internationally respected peer-reviewed journal, echoed those findings in a three-part series on low back pain published in 2018. In the series, Lancet authors called for “a worldwide recognition of the disability associated with the disorder” and “the removal of harmful practices,” such as prescribing opioids for chronic low back pain.
Payers taking notice
While soaring low back pain costs don’t appear in many headlines, commercial health insurers are slowly and gradually updating their rules to steer more patients toward lower-cost, conservative treatments, such as chiropractic care.
UnitedHealthcare, for example, announced in October last year that it will waive the deductible or co-pay for some employer-sponsored plans if members select chiropractic care or physical therapy for their low back pain. UnitedHealthcare estimates that by 2021 this benefit design will reduce the number of spinal imaging tests by 22%, spinal surgeries by 21%, opioid use by 19%, and lower the total cost of care for employers and plan members. The health plan benefit was spurred by research from UnitedHealth Group’s Optum subsidiary which determined that conservative low back pain care pathways could save the payer $230 million in annual medical expenditures.
By removing co-pay and deductible barriers, as UnitedHealthcare is doing, more patients with low back pain can access lower-cost, more effective care from DCs. In turn, and by educating more medical providers about the efficacy of chiropractic care, they can drive down the two greatest contributors to healthcare costs in the U.S. for the past 20 years.
About the author:
Sherry McAllister, DC, is executive vice president of the Foundation for Chiropractic Progress (F4CP). A not-for-profit organization, the F4CP provides information and education regarding the value of chiropractic care and its role in drug-free pain management.