Medicare Overspending and Waste: Chiropractic’s Role

The Medicare expense is one of the larger burdens on the budget ($472 B–about 14%) and it’s not getting any better.

Every year the argument about the Sustainable Growth Formula (SGF) comes up in front of Congress.  Physicians want more money to align with an increased cost of living.  But rarely does Medicare ever take a hard look at some of the procedures they pay for and evaluate the costs versus the benefits.

I have written about the massive wastes within the spinal surgery realm of Medicare.  A specific example has to do with the increase in the more complex spinal fusions instead of simple decompressive surgeries.  Many times the cost, similar outcomes and more dangerous.

This is representative of the waste in Medicare.  I can tell you, with my built-in bias of course, that chiropractic care is one of the least appreciated services provided within the Medicare system.  Chiropractic care is a massive cost savings, NOT an add-on cost like many believe.  For non-surgical spinal complaints, it is around a 30% cost savings.  When factored into all spinal complaints, the cost savings is greater.

But how much does chiropractic care cost Medicare?  My profession was under the spotlight in 2006 when Medicare declared that a large percentage of the claims paid by Medicare were “inappropriate.”  This had little to do with the actual care and more to do with the documentation of that care.  Medicare’s rules for documentation are clear-cut, but quite lengthy and can be a challenge to dot every “i” and cross every “t.”  All of this made a little more challenging by the fact that Medicare only pays for a single service (manipulation) when done by a chiropractor.  Our office spends about 1 hour on a new Medicare patient (in general, the Medicare patient is more challenging because he or she is more likely to be on multiple medications, have had surgeries, have an increased risk of low bone density, etc…) and I get paid for about 3 minutes of this actual time.  Same thing with a recurring visit–we spend about 15 minutes and get reimbursed for that same 3 minutes.

This particular study looks into what percentage of Medicare payments went for chiropractic.  Here’s what they found:

  1. Chiropractic spinal manipulation grew 13% from 2002 to 2004, declined 5% through 2008.
  2. In 2008, 1.7 million beneficiaries (6.9%) used chiropractic services.
  3.  Chiropractic services accounted for about 1/10th of 1% of overall Medicare expenditures.

Yup.  0.1%.

For a profession that has the potential to save mass amounts of money (and already DOES), our reimbursement does not even register as a blip on the radar screen of costs.

To me, this reinforces the fact that chiropractic care is, without any doubt whatsoever, THE highest value in healthcare available.  Nothing else even comes close.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.