Just in case you thought I was going to get political, get your disappointment over with now. Or at least, not Republican versus Democrat political.
This blog is not long enough, nor do I have the time to point out all that is wrong with the current concept of the Affordable Care Act. But I can help illuminate one glaring problem. “Health care” in this country just costs too damn much. The waste, fraud and abuse is at epic proportions and nothing short of the downfall of medicine as we know it will change this. There’s just too much money invested in the machine for anyone with any shred of reality left to believe otherwise.
However, amidst the financial carnage lies an answer to at least some of the woes we can identify. This particular set of “woes” is wrapped up in what those in the insurance industry like to call “non-surgical spinal care.” At one of the largest (if not THE largest) health insurance companies in the US, orthopedics is the number one cost driver. Of the orthopedic expenses, the single largest line-item cost is non-surgical spinal care, sitting at about 45% of overall orthopedic costs. This number is so large, not because of the massive costs of treating a case of back pain, but rather because of the sheer volume of cases of non-surgical spinal complaints.
So what if you could shave a small percentage, maybe 30%, off the top of this large chunk of orthopedic costs? The direct cost savings are in the billions of dollars. DIRECT only.
Given my bias, by now you should know that I’m talking about chiropractic care for the management of non-surgical spinal complaints. The data encompassing millions of episodes of musculoskeletal complaints (yes–millions) leaves chiropractors at the top of the hill as far as the most cost-effective provider to manage this type of case. This occurs mainly because the average DC can truly manage the care. Only a small percentage of cases presenting to a chiropractors office FIRST will need to leave that office for his or her episode. Contrast this with PCPs, PTs, ERs and orthopedic doctors. Very few of these providers can manage these cases within his or her office alone (BTW–writing a prescription would be considered to have another provider, in this case the pharmacy, involved, driving up costs).
Sadly, only 28% of these cases start with a chiropractor. Worse, if a chiropractor is not part of the initial treatment, less than 7% of the time will that patient end up in a chiropractic office.
The bottom line is that chiropractic care is the only treatment path that follows the best evidence of spinal care, meaning:
- Imaging should NOT be used at the initial stages of treatment (orthopedic doctors order imaging at a very high rate).
- Opioids are not recommended as the first line medication (PCPs will frequently lead with Percocet or Vicodin).
- Injections should never be used in the initial stages of a back pain episode.
- Manipulation is added in almost every case seen in a chiropractor’s office.
Here’s a bonus. Remember when I said that chiropractic care led to a DIRECT 30% savings? This does not include the indirect cost savings which can include:
- Additional cost savings when comparing chiropractic care treatment in surgical spinal care episodes
- Practically unfathomable savings due to less drugs and less side effects from these drugs (I’ve written an entire eBook on the side effects of NSAIDs)
So here’s the real problem. Despite the evidence, chiropractic care remains the truly hidden gem of healthcare. Even looking at this particular study that suggests that mainstream medicine is getting WORSE at managing back pain, me and my colleagues are still limited to being heroes in our own little offices, rather than across the healthcare spectrum. But there is an answer over the horizon…
The employers. Yes, it may very well be that the members of your HR department could help change the face of health care. Imagine that. Going forward, the group that truly wants to save money on health care is the employers. They truly have the most to lose with treatments that run completely opposite of what the medical literature suggests is the best care pathway.
I guess only time will tell how it is going to play out.