Cost Of Care For Common Back
Pain Conditions Initiated With
Chiropractic Doctor Vs. Medical
Doctor/Doctor Of Osteopathy
As First Physician: Experience
Of One Tennessee-Based General
AUTHORS: Richard L. Liliedahl, M.D.; Michael D. Finch,
Ph.D.; David V. Axene, FSA, FCA, MAAA; and Christine
M. Goertz, D.C., Ph.D.
The Palmer Center for
conducts studies at facilities
on each Palmer campus,
including the William and
Jo Harris Building on the
OBJECTIVE: The primary aim of this study was to determine
if there are differences in the cost of low back pain
care when a patient is able to choose a course of treatment
with a medical doctor (M.D.) versus a doctor of chiropractic
(D.C.), given that his/her insurance provides equal access
to both provider types.
METHODS: A retrospective claims analysis was performed
on Blue Cross Blue Shield of Tennessee’s intermediate and
large group fully insured population between Oct. 1, 2004
and Sept. 30, 2006. The insured study population had open
access to M.D.s and D.C.s through self-referral without any
limit to the number of visits or differences in copays to
these two provider types. Our analysis was based on
episodes of care for low back pain. An episode was defined
as all reimbursed care delivered between the first and the last
encounter with a health care provider for low back pain. A
60-day window without an encounter was treated as a new
episode. We compared paid claims and risk-adjusted costs
between episodes of care initiated with an M.D. with those
initiated with a D.C. Results: Paid costs for episodes of care
initiated with a D.C. were almost 40 percent less than
episodes initiated with an M.D. Even after risk adjusting
each patient’s costs, we found that episodes of care initiated
with a D.C. were 20 percent less expensive than episodes
initiated with an M.D.
CONCLUSIONS: Beneficiaries in our sampling frame had
lower overall episode costs for treatment of low back pain
if they initiated care with a D.C., when compared to those
who initiated care with an M.D.
The entire article can be found at:
J Manipulative Physiol Ther 2010;33(9):640-643.
One of the authors of this abstract, Dr. Christine M. Goertz, is
Palmer College of Chiropractic’s Vice Chancellor for Research
and Health Policy.