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Chiropractic

Chiropractic Benefits: A Solution to Lower Overall Costs. Chiropractic . Benefits, case management, and internal processes to improved outcomes, value, and satisfaction . Respectfully submitted by Dr. Ronald J. Farabaugh to AMI.

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Chiropractic

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  1. Chiropractic Benefits:A Solution to Lower Overall Costs Chiropractic Benefits, case management, and internal processes to improved outcomes, value, and satisfaction. Respectfully submitted by Dr. Ronald J. Farabaugh to AMI A Cost Effective Solution for Escalating Costs Associated with Low Back Pain, Neck Pain, and Headaches

  2. Background information

  3. Two approaches…

  4. Entry Point…

  5. Cost by Entry Point…

  6. ASHN Stats… 16 (requested) – 12 (authorized) = 10 (received) Notes: Patients do NOT return for care they feel they do not need, AND Doctors do not provide more than the patient needs. So…how much oversight is really required?

  7. Decreasing Symptoms Conflicts in Chiropractic Improving Function/Correction Symptoms “Correction” Biomechanical Model Improved Health Up to two rounds of up to 12 visits Evidence-based = Mod to Strong Ex. Up to 80 visits - pre-pay. Evidence = weak Lifetime care Evidence = weak

  8. The Overall National Problem… LBP and neck pain are extremely common conditions that consume large amounts of health care resources. 26% of US adults surveyed in 2002 reported back pain in the previous 3 months. 14% had experienced neck pain. The lifetime prevalence of back pain is estimated to be 85%. LBP alone accounts for 2% of all physician office visits; only routine examinations, hypertension, and diabetes result in more. Annual national spending on spine-related problems is estimated to be $85 billion in the US an inflation-adjusted increase of 65% compared with 1997. Expenditures and health status among adults with back and neck problems. Deyo et al. JAMA. 2008 Feb 13;299(6):656-64.

  9. BWC-Ohio: Results of an assault on conservative care Pharmeceutical Reimbursement 1. 1998 $57,026,132 2. 1999 $67,461,430 3. 2000 $84,452,586 4. 2001 $106,959, 155 5. 2002 $116,252,892   6. 2003 $130,000,000 600,000 increase in number of prescription from 1998-2002. ( 1.2 million prescriptions 1998/ 1.8 million prescriptions 2002 )

  10. The Solution… Conservative care, especially early intervention using doctors of chiropractic.

  11. Early Use of a DC… Results. 1,885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The multivariate model's AUC was 0.93 (95% CI 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery. Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Keeney et al. Spine 2012 Dec 12.

  12. CCGPP: up to 12 visits initially, and then up to 12 additional visits for a second round. PLUS: up to 4 visits per month, to be re-evaluated at a minimum of 12 visits. ODG: up to 18 visits. 6 visit initial eval. PLUS: up to 1-2 visits every 4-6 months.

  13. Barriers… DCs don’t read! Unfamiliarity with treatment guidelines. Not current with literature. Inconsistent re-evals. Poor documentation. Poor compliance with identifying complicating factors, comorbidities, and/or barriers to recovery. No formal discharge, and/or transition to wellness or chronic pain management. Hesitant to refer for multi-disciplinary, multi-modal care. Distrust of networks due to ACN, ASHN. Survival mode due to 30 year old fee schedules, therefore lack adequate staff to complete excessive paperwork per network.

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