Blue Cross-Blue Shield Study Shows Chiropractic More Cost-effective for Low Back Pain
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 (MD) versus a doctor of chiropractic (DC), given that his/her insurance provides equal access to both provider types. A retrospective claims analysis was performed on Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population between October 1, 2004 and September 30, 2006. The insured study population had open access to MDs and DCs through self-referral without any limit to the number of visits or differences in co-pays to these 2 provider types.

The researchers’ 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. They compared paid claims and risk adjusted costs between episodes of care initiated with an MD with those initiated with a DC. Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient’s costs, episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD. The investigators concluded that patients had lower overall episode costs for treatment of low back pain if they initiated care with a DC, when compared to those who initiated care with an MD.

Liliedahl RL, Finch MD, Axene DV, Goertz CM. 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 Health Insurer. J Manipulative Physiol Ther. November – December 2010;33(9):640-643.

Commentary from James Brantingham, DC, PhD:

This research confirms previous research (Nelson et al, 2004) which also strongly demonstrated decreased costs if chiropractic care was part of the benefit, and that chiropractic is not an “add on” cost on top of medical care (Metz, 2004). Employers, employees and third party payers should be aware that a “chiropractic benefit” in their plan will save money for their businesses or insurance plans in the long term and is not an “extra cost” but a wise choice.

Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. J Manipulative Physiol Ther. Oct 2005;28(8):564-569.

Metz RD, Nelson CF, LaBrot T, Pelletier KR. Chiropractic care: is it substitution care or add-on care in corporate medical plans? J Occup Environ Med. Aug 2004;46(8):847-855