Chiropractic Use in the Medicare Population
Written by Editor   
Sunday, November 09, 2014 10:41 PM

The purpose of a recent study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

National surveys and other data show chiropractic use prevalence rates among those 18 years and older, ranging between 5.6% and 8.6% in the United States. Among Medicare beneficiaries 70 years and older, chiropractic use is less prevalent, with 2 studies indicating annual rates ranging between 4.1% and 5.4%.  For younger Medicare beneficiaries, chiropractic prevalence rates are closer to national rates, ranging between 6% and 7%. Although informative, these estimates are not reflective of the population that commonly seeks care from doctors of chiropractic — namely, persons seeking treatment of spine-related health conditions. Prevalence of chiropractic use is likely higher in the population of Medicare beneficiaries with back and neck conditions, but how much higher is not known.

Medicare covers several treatment options ranging from the noninvasive like chiropractic and physical therapy to the more invasive, such as steroidal injections and surgery. Studies have shown that the technologically intensive treatment types have grown more dramatically, both in use and in expenditures, than the noninvasive kind over the past 15 to 20 years. Although these studies document the increasing use of interventional treatments, they also note that population-level improvements in outcomes and disability have not improved commensurately.

Recent research, however, suggests that chiropractic use benefits older Medicare beneficiaries (>70 years) by protecting them against decline in function and self-rated health (SRH). Because that study used Medicare claims to compare outcomes between users of chiropractic and users of medical care treatments in uncomplicated back conditions over a 2-year period, it represents a real-world approximation of the relative benefit of chiropractic use on health outcomes.

Given the escalating costs of treatment and the ramifications of disability on future dependency, it is important to understand the prevalence and the relative effect on health and care, costs of chiropractic use among age-eligible Medicare beneficiaries with spine-related problems. Equally important is how patients view the quality of care received from different treatment types. If treatments have comparable effects on health, but disparate care costs or satisfaction, then policy makers may consider incentives or disincentives to promote particular treatments for certain conditions.

This study found prevalence of chiropractic use among age-eligible Medicare beneficiaries consistent with that of the US adult population, but among those seeking care for spine problems, we observed a much higher prevalence rate. Service volume trends between 1997 and 2006 showed growth in the average number of services used to treat spine conditions, although the percentage growth of chiropractic services was nearly flat compared with overall service volume growth. Medicare spending on spine conditions grew as a consequence of higher service volume and more expensive services, although spending on chiropractic was relatively flat and declined as a percentage of total spending among those choosing chiropractic.

This study provides evidence of a protective effect of chiropractic against 1-year declines in functional and self-rated health (SRH) among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

Source:  http://chiro.org/wordpress/2014/11/09/chiropractic-use-in-the-medicare-population/