As a practicing chiropractor here in sunny Mesa I can tell you that seeing injured workers in my office is a rare event.
Even rarer is a patient who was injured at work who was sent in by his or her HR department to my office for care. Almost always it is a current patient who was injured at work and wants to be seen in our office for care because they know how effective we are.
It is rare for me to get frustrated over anything, but having a representative for a patient’s workman’s comp insurance tell me “we don’t refer to chiropractors” just irks me to no end. Even worse is an existing patient who comes in for care of a work injury and then is told, ILLEGALLY, that they can’t come into our office for care. The worker is scared to go against his or her employer, even after assurances by us that they can see us for treatment.
Here in AZ, with a few self-funded exceptions, patients all have a right to see the provider of their choice. They may be required to make a single visit to a provider that is chosen by the employer, but that is all they have to do. However, once they have seen a provider twice, that provider controls all care for the course of the injury.
So the patient sees the provider that the employer requires. That provider (which is almost always one of the two larger occupational or urgent care clinics that use PTs for treatment) then coerces the patient to come back for another visit under one pretense or another and they get them back in quick. Frequently the next day.
The patient ends up falling into the scheme and is NEVER given his or her rights, which would be to see a chiropractor if he or she chose to.
I would just be whining and complaining in this article if it weren’t for one important fact…
It’s a very, very bad idea to NOT see a chiropractor first or at least have one on the care team as soon as possible. Why? Here are a few of the reasons:
- The alternative is far more costly.
- Patients take longer to get back to work and are more likely to become disabled.
- Medications that actually promote chronicity are more likely to be used.
- Patients are generally not as happy with the care they receive.
As a chiropractor one would think that I’m just being petty and biased. But regular readers of the Rantings know that I can back up everything that I put in writing. This is no exception.
In this particular study, researchers looked at 14,787 injured workers over the course of 8 years to evaluate care patterns for low back pain. They identified 5 distinct patterns of care for the injured workers:
- Information and Advice (59% of injuries): The first 6 weeks basically consisted of information gathering or advice seeking but no overriding pattern. This included simple office visits, laboratory tests, emergency department or hospital visits, talk therapy, or visits involving imaging (x-ray, ultrasound, CT, or MRI) but no other procedures.
- Complex Medical Management (2% of injuries): Included more than a single visit to a physician for nerve blocks, surgeries, or comparable procedures. This is expensive and fragmented care and runs completely contrary to the way low back pain should be managed.
- Chiropractic (a paltry 11%): Self-explanatory. Used by the most intelligent injured workers (ok…so I made this part up).
- Physical therapy (11%): Self-explanatory.
- Dabble (17%): Workers who had one visit to a non-chiropractic physician, chiropractic physician or PT, or at most one visit to two or more of these categories.
Overall, being good at math, it looks like 89% of the injured population were not under the care of a chiropractor. Keep this in mind as we go through the rest of the study. I know that here in AZ, this low percentage is likely a result of steerage by the insurance company, HR employees who do not understand how effective chiropractic care is, as well as the schemes played at the patient’s expense by other providers that treat injured workers.
After identifying the 5 patterns, researchers looked at well accepted guidelines for the treatment of low back pain that is backed up by medical research. There were 11 guidelines that were used to evaluate the 5 treatment patterns, but here are some snippets to think about:
- Early use of (MRI) has been linked to prolonged disability, higher medical costs, and greater use of surgery at the same time finding no benefit on health or disability outcomes for low back pain.
- Chiropractic has been shown to lead to lower likelihood disability recurrence over non-chiropractic physicians and physical therapists.
- In addition, chiropractic care with shorter duration (likely meaning more effective chiropractic care that seeks to get the patient better ASAP) also leads to shorter disability duration.
- More frequent and stronger dosages opioids leads to longer claim durations. Worse, the likelihood for a catastrophic claim (total cost of $100,000 or more) when spinal surgical procedures were performed increased 10-fold when treatment included opioid use.
It goes without saying that chiropractic care is the antithesis of opioid use.
With all this in mind, here are a few snippets from the study:
- Care to injured workers that was in line with 10 of 11 guidelines led to lower total costs.
- Of the five patterns, complex medical management followed the guidelines the worst in regards to imaging, surgeries, and medications as well as having the highest total costs.
- Complex management was also linked to the highest rates of prescriptions for four of the seven drug classes—opioids, other pain medications, SSRI/SNRI/tricyclics, and anxiolytics/sedatives/hypnotics.
- The PT group was highest in NSAIDs, muscle relaxants, and oral steroids.
- Chiropractic care was on the opposite end of the spectrum, leading to the most alliance with accepted guidelines, lower total costs and the lowest prescription rates in all seven classes of drugs.
- Previous treatment choices by injured workers influenced future choices for another injury. This means that, if someone did NOT choose chiropractic care for an initial work injury, if they got injured again they were not likely to seek chiropractic care for the second episode.
There is really not much more to say. Except that maybe all of this information is not new and is consistent with the findings from a large handful of other studies. Hopefully you can understand my frustration with the care of injured workers here in Arizona, as well as the extreme confusion when it comes to chiropractic care being treated as the red-headed stepchild of healthcare when, in reality, we really rock when it comes to doing what we do.
By avoiding or discouraging chiropractic care for injured workers here in AZ, workers are not getting the best and most cost-efficient care possible. That, quite frankly, is a travesty.