Acupuncture and Chiropractic Care Utilization
Written by Editor   
Monday, November 30, 2015 09:27 AM

A recent study underscores why so many chiropractic patients have to go “out of network” in order to get the care they need: Managed care appears to be be effectively locking them out. This study reviews chiropractic and acupuncture utilization by adults with chronic musculoskeletal pain at Kaiser Permanente Northwest, an HMO.

Evidently, physician referral for acupuncture is strictly limited to chronic pain complaints, while referral for chiropractic benefits is limited to acute pain. This is why 43-54% of those individuals who sought chiropractic care had to seek “out-of-plan” (aka out-of-pocket) care.  Physician referrals within this Kaiser program was tipped in favor of acupuncture, with 55% of them being referred for care, versus only 9% of the chiropractic patients.

The study was conducted to describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture.  The study concludes better acupuncture and chiropractic integration could offer potential opportunities for improved management algorithms and more efficient utilization of resources. The potential for these 2 types of care to serve as noninvasive alternatives to pharmacologic and procedural interventions, or as tools to facilitate the reduction of chronic pharmacotherapy, would seem to warrant further investigation.

Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate.  Of 6,068 survey respondents, 32% reported acupuncture use, 47% reported chiropractic use, 21% used both, and 42% used neither. For 25% of patients using acupuncture and 43% of those using chiropractic care, utilization was undetected by the EMR. Thirty-five percent of acupuncture users and 42% of chiropractic users did not discuss this care with their health maintenance organization (HMO) clinicians

A majority of participants had used acupuncture, chiropractic care or both. While benefit structure may materially influence utilization patterns, many patients with chronic musculoskeletal pain use acupuncture and chiropractic care without regard to their insurance coverage. A substantial percentage of acupuncture and chiropractic use thus occurs beyond detection of EMR systems, and many patients do not report such care to their HMO clinicians.