The cost of healthcare continues to be a burden on the economy. Recent studies indicate that healthcare spending accounted for 16.2% of the US gross domestic product (GDP) in 2008. Congress, along with President Obama. has recently enacted a sweeping healthcare reform law that addresses many issues in this area. Despite the enactment of the Patient Protection and Affordable Care Act. there is every indication that healthcare spending in the United States will continue to rise. However, chiropractic can be part of the solution to this growing problem, especially within every workers' compensation system in the United States. In a 2010 study by Stupar. Pierre. French, and Hawker on the association between low back pain and osteoarthritis of the hip and knee, researchers found that 49% of the general population reported a six-month prevalence of low back pain, with 11% reporting back pain to be so significant that it seriously limited their work activities. Consequently, employee complaints of low back pain and related arthritis represent a significant burden to the workers" compensation system, especially if we take into account the long-term consequences of untreated injuries and the related costs associated with an injured worker. Wasiak. Kim. and Pransky (2007) reported in the Journal of Occupational Medicine that thcirfindings of a study sponsored by the Libert} Mutual Research Institute for Safety did not support a benefit of longer chiropractic care in preventing work-related disability in occupational low back pain. A limitation in that study was that it did not actively seek noncomplicatcd. nonscverc occupational low back pain in an attempt to homogenize the results. Excluded from the study were more serious cases where comorbidities such as hcrniatcd discs, whereas McMorland ct al. (2010) reported that more than 250.000 patients undergo elective spinal disccctomics yearly, mam as scqucllac from occupational injuries. The study reported. "Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%. all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery" (McMorland ct al.. 2010. page of quote). A study by Lcgorrcta (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%. hospitalizations were reduced by 41%. back surgery was reduced by 32%. and the cost of medical imaging, including x-rays and MRIs. was reduced by 37%. Furthermore. 95% of the patients who received chiropractic care said they were satisfied with their treatments. Utilizing chiropractic care as the first treatment option for back pain was estimated to have the potential to reduce US healthcare costs by more than $28 billion annually. These types of conditions that arc excluded from the Journal of Occupational Medicine and Liberty Mutual's study render a full perspective on the benefits of chiropractic care, both as a first-line treatment modality and for the care of more serious conditions than noncomplicatcd low back pain. Municipalities such as the New York State Workers" Compensation Department have adopted treatment guidelines based upon the work and conclusions of the American Academy of Occupational Medicine, which they hired to create treatment guidelines with an apparent goal of limiting care. Cifucntes. Willcts. and Wasiak (2011) reported another study sponsored by the Libert} Mutual Research Institute for Safety in the Journal of Occupational and Environmental Medicine."In work-related nonspecific low back pain, the use of health maintenance care provided by physical therapists or physician sen ices was associated with a higher disability recurrence than in chiropractic sen ices or no treatment." Cifuentes et al. went on to report. "In general...those cases treated by chiropractors eonsistenth tended to have a lower proportion in each of the categories for severity proxy compared to the other groups: fewer used opiates and had surgery. In addition, people who were mostly treated by chiropractors had. on average, less expensive medical sen ices and shorter initial periods of disability than cases treated by other providers." Many recent, independent studies confirm that chiropractic can be an extremely effective modality in the treatment of low back pain and. by extension, the onset of ostcoarthritis. which should be of particular interest to workers" compensation boards at this time: Regarding the link between low back pain and the onset of ostcoarthritis. Stupar et al. (2010) have shown that 40% of hip or knee osteoarthritis patients have also reported low back pain. Thus, research indicates that low back pain is often a conclusive predictor for future leg pain and disability, and therefore suggests that alleviating low back pain may positively impact future hip pain and function. • A 2009 study by Aspcgren ct al.and a 2005 study by DcVocht. Pickar. and Wilder have independently concluded that chiropractic care is a safe, highly effective treatment choice for low back pain patients and. perhaps most importantly, that low back pain cannot be ignored. especially in light of the fact that it often can be treated in a very cost-effective manner. Considering that a 2009 stud> by Russo. Weir, and Elixhauscr concluded that ostcoarthritis is the second cause of hospital stays (only behind coronary artery disease), the potential long-term healthcare costs of low back pain as a precursor to ostcoarthritis arc staggering. The study by Aspegren et al.(2009) also concluded that 81.5% of workers with an acute injury causing low back or neck pain reported immediate post-treatment relief with chiropractic treatment, with that percentage increasing over time. A 2005 study by DcVocht ct al. found through objective clcctrodiagnostic studies that 87% of the chiropractic patients they studied exhibited decreased muscle spasms. In 2009. Painter reported that Consumer Reports conducted an independent survey of 14.000 subscribers who rated hands-on therapy as the first treatment of choice for low back pain. The report went on to state that 88% of those who tried a chiropractic adjustment reported positive outcomes and 59% were "completely" or "very" satisfied versus 34% who were "highly" satisfied when treated by a primary care physician. A 2010 study by CTShaughnessy. Drolct. Roy. and Dcscarrcaux estimated that serious side effects from a chiropractic adjustment were less than one out of every 3.700.000. to one out of every 1.000.000 with low back adjustments (the incident was so low. they had to use a range). In contrast, one of the most common medically prescribed and over-the-counter treatments for low back pain is nonstcroidal anti-inflammatory dnigs (NSAIDs). It was reported by the American College of Gastrocnter-ology in 2010 that 14 million Americans with arthritic conditions take NSAIDS regularly, and up to 60% will have gastrointestinal side effects as a result. According to a 2010 Virginia Healthcare and Hospital Association study, the average nonsurgical hospital stay for back problems in Virginia in 2009 was $15,059 and $77,107 with surgery. A Virginia study by North. Kidd. Shipley, and Taylor (2007) revealed that the cost to use spinal cord stimulation to treat failed back surgery syndrome was $117,901 and unsuccessful attempts at reoperation cost an additional $260,584. In contrast. MEDSTAT. as reported by Chiropractic Lif-ccarc of America (2009). has estimated that the average cost of chiropractic care per patient is $3,799. A 2004 stud> by Lcgorreta compared more than 1.7 million insured patients seeking treatment for back pain. The outcomes showed when chiropractic care was compared to the standard medical approach, the cost of treatment was reduced by 28%. hospitalizations were reduced by 41%. back surgery was reduced by 32%. and the cost of medical imaging, including x-rays and MRIs. was reduced by 37%. Furthermore. 95% of the patients who received chiropractic care reported in the study that they were satisfied with their treatments. Utilizing chiropractic care as the first treatment option for back pain was estimated to have the potential to reduce US healthcare costs by more than $28 billion annually. A 2008 study by Cook. Cook, and Worrell reported that manual therapy in a hospital-based setting significantly reduced hospital charges. A 2007 study by Sarnat. Wintcrstein. and Cambron re- ported that there was a 60.2% reduction of in-hospital admissions with a 59% decrease in hospital stays and a 62% reduction in outpatient surgeries and procedures when chiropractic was utilized. Furthermore, there was an 85% reduction in pharmaceutical costs. The conclusions of these recent studies are consistent: chiropractic is less expensive and returns people to work fastcrand with less disability, thereby alleviating the burden on the workers" compensation system and overall economy. This begs the question: If chiropractic were utilized more frequently, how many billions of dollars spent on healthcare in the US could have been saved? With mushrooming annual budgets that include multibillion-dollar shortfalls, most states arc now under extreme pressure to cut costs and prevent unnecessary spending. One of the largest areas of expenditure in every state "s budget is healthcare spending through their respective workers" compensation and Mcdicaid systems. Ironically, chiropractic is an independently verified treatment option that could save those healthcare systems billions of dollars: study after study proves this. To summarize, chiropractic care lias been shown repeatedly in various US and international studies to be more effective at helping injured workers return to work faster and at significantly lower costs than other treatment modalities. Table 1 below provides representative summaries of additional studies. Reference Florida Workers" Compensation Board "' Study examined 10.652 workers who sustained back-related injuries. Individuals who received chiropractic care as compared with standard medical care had a 51.3% shorter temporary total disability duration. 58.8% lower treatment costs, and a 20.3% hospitalization rate versus 52.2% in the medical care group. Utah Workers' Compensation Board Study 17 Back-related injuries treated by chiropractors produced a tenfold savings as compared with medical doctors ($68.38 vs. $668.39). Australian Workers" Compensation Study l8 Individuals who had work-related mechanical low back pain who received chiropractic care for their back pain returned to work four times faster (6.26 days vs. 25.56 days) and their treatment was four times less costly ($392 vs. $1,569) than those who received treatments from medical doctors. North Carolina Workers' Compensation Patients l9 A retrospective review of 43,650 claims from 1975 to 1994 showed that the average cost of treatment, hospitalization. and compensation payments (for treatment of strain injuries, specific body parts, and low back injuries) were much less for patients treated by DCs than they were for patients treated by MDs. Average treatment cost for a patient seeing a DC was $663. Average treatment cost for a patient seeing an MD was $3.519. Chiropractic Treatment for Low Back and Neck 2(1 For the treatment of low back and neck pain, receiving chiropractic treatment showed a reduction in the rates of surgery, advanced imaging, inpaticnt care, and plain-film radiographs. Costs of Low Back Care 2I 6.183 patients were studied who first had contact with cither a medical or chiropractic provider. Total insurance payments were much less when initial treatment was provided by a chiropractor. The studies cited above and the other studies cited in this article all highlight the common sense conclusion that fair and equitable access to chiropractic, along with fair and reasonable rates of reimbursement for doctors of chiropractic, clearly serve the needs of the many injured workers in New Jersey, and in addition, should provide significant cost savings to the state. References Stupar. M.. Pierre. C. French. M. R.. & Hawker. G.A. (2010). The association betw een low back pain and osteoarthritis of the hip and knee: A population-based cohort study. Journal of Manipulative and Physiological Therapeutics. 33(5). 349-354. Wasiak. R.. Kim. J.. & Pransky. G. (2007). The association between timing and duration of chiropractic care in work-related low back pain and work-disability outcomes. Journal of Occupational and Environment Medicine, 49(10). 1124-1134. I.egorrcta. A.P. (2004). Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine, 164(18). 1985-1992. Cifuentcs. M.. Willets. J.. & Wasiak. R. (2011). Health mainte nance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine. 53(4), 396-404. Aspegren. D.. Encbo. H. A.. Miller. M.. White. I,.. Akuthota. V.. Hyde. T. E.. & Cox. J. M. (2009). Eunctional Scores and subjective responses ot injured worker with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics. 32(9). 765-77'1. DeVocht. J. W.. Pickar. J. G.. & Wilder. I). G. (2005). Spinal ma nipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics. 28(7). 465-471. Russo. A.. Wier. E. M.. & Elixhauser.A. (2009. September). Hos pital utilization among near-elderly adults, ages 55 to 64 years. 2007. Agency for Healthcare Research and Quality. Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp Painter. E. M. (2009. April 10). Consumer reports survey shows hands-on therapies were the top-rated treatments. The Chiroprac tic Rescue Organization. Retrieved from http: www.chiro.org/ LINKS ABSTRACTS Hands on Therapies.shtml 9. American College of Gastroenterol- ogy. (2010). The Dangers of Aspirin & NSAIDS. Retrieved from http: www. acg.gi.org/patients/women/asprin.asp 10. O'Shaughnessv. J.. Drolet. M., Roy, J-F., & Descarreaux, M. (2010). Chiropractic management of patients' post-disc arthroplasty: Kight case reports. Chiropractic & Osteopathy. 18(7). Re trieved from http: www.ehiroandosteo. com/content/pdf/1746-1340-18-7.pdf Chiropractic Lifecare of America. (2009). The MKDSTAT Project. Learn ing. Retrieved from http: wwvv.cla- healthcare.com learning indcx.html Virginia Hospital and Healthcare Association. (2010). MSDRG 552 Medi cal Back Problems wo MCC. Virginia Hospital and Healthcare Association PricePoint System. Retrieved from http:// www.vapricepoint.org Report INP.aspx 13. Virginia Hospital and Healthcare Association. (2010). MSDRG 460 Spinal Fusion Kxc Cervical wo MCC. Virginia Hospital and Healthcare Association PricePoint System. Retrieved from http://www.vapricepoinl.org/ Report_INP.aspx Lcgorrcta. A. P. (2004). Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine, 164. 1985-1992. Cook. C. Cook. A.. & Worrell. T. (2008). Manual therapy provided by physical therapists in a hospital-based setting: A retrospective analysis. Journal of Manipulative and Physiological Therapeutics, 31(5). 338-343. Sarnal. R. L.. WiiUcrslcin. J.. & Cainbron. J. A. (2007). Clinical utilization and cost outcomes from an intcgrativc medicine inde pendent physician association: An additional 3-year update. Journal of Manipulative and Physiological Therapeutics. 30(4). 263-269. Jan is. K. B.. Phillips. R. B.. & Morris. E. K. (1991). Coslpcrcase comparison of back injury claims of chiropractic versus medical management forconditions with identical diagnostic codes. Journal of Occupational Medicine. 33(8). 847-852. Ebrall. PS. (1992). Mechanical low-back pain: A comparison of medical and chiropractic management within the Victorian work care scheme. Chiropractic Journal of Australia. 22. 47-53. Phelan. S. P.. Armstrong. R. C. Knox. D. G.. Hiibka. M. J.. & Ainbindcr. D. A. (2004). An evaluation of medical and chiropractic provider utilization and costs: Treating injured workers in North Carolina. Journal of Manipulative and Physiological Therapeutics. 21(7). 442-448. Nelson. C. F, Metz. R. D. & LaBrol. T. (2005). Effects of a man aged chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. Journal of Manipulative Physiological Therapeutics. 28(8). 564-569. 21. Stano. M.. & Smith. M. (1996). Chiropractic and medical costs of low back care. Medical Care. 34(3). 191-204. Dr. Mark Studin is an adjunct assistant professor in clinical sciences at the University of Bridgeport College of Chiropractic and a clinical presenter for the Stale of New York at Buffalo. School of Medicine and Biomedical Sciences for post-doctoral education, teaching MR1 spine interpretation and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the legal community (www. LayvyersPIProgram.com) and teaches MIU interpretation and triaging trauma cases to doctors of all disciplines nationally (www.TeachDoctors.com). He can be reached at DrMark@ TeachDoctors.com or at 631-786-4253.
