Insurance coverage study: Chiro vs MD for some care
Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs Antonio P. Legorreta; R. Douglas Metz; Craig F. Nelson; Saurabh Ray; Helen Oster Chernicoff; Nicholas A. DiNubile Arch Intern Med 2004;164 1985-1992 http://archinte.ama-assn.org/cgi/content/abstract/164/18/1985?etoc
.................
I think there are some important observations about this study that serve to qualify any conclusions that availability of insurance benefits for chiropractic care results in lower medical care costs.
This study looked at claims data on 1.7 million members of a managed care organization over 4 years. It compared total claims data and neuromuscular diagnosis claims data of members with and without a 40 visit/yr chiropractic benefit. It also analyzed claims data for neuromuscular diagnosis for chiropractors and MD’s minus those associated with surgery. Based on analyses of the data, the authors conclude that the existence of chiropractic coverage may reduce overall health care expenditures.
The sheer amount of data within the cohort populations and the "natural" setting of the trial increase the risks for confounding results. There may just be too much data and/or variables to be able to account for all things that might introduce a statistically significant bias within the study.
The study noted a disparity in demographics of the two groups; thus the study analysis had to have this disparity calculated out. It would have been nice had the populations not had such an obvious disparity to begin with. For example, although members with chiropractic coverage had a 12% lower annual medical care cost, this became 1.6% (still statistically significant) when adjusted for demographic differences. That’s quite an amount to be calculated out where a direct measurement of more similar demographics could have eliminated the bias in the first place.
The study concluded that six percent of people with neck and back pain went to a chiropractor versus MD when given the choice. The study does not provide data to compare how close the six percent compared to the total number of members with neck or back pain who saw a chiropractor. That is, if 6% of those with neck or back pain that chose to see a chiropractor instead of an MD is 100 patients, it would be nice to know how many members are seeing a chiropractor for neck or back pain. If that number is 500, where did the other 400 members seeing the chiropractor for neck and back pain come from? One step further, this could make episode of care cost comparison analyses less meaningful if those extra 400 members are included. That is because this represents 400 (more or less) episodes of care that would not have existed had there been no chiropractic benefit. A true episode of care cost analysis would be one made on only those members who are seeing a Chiropractor instead of a MD.
The specific data analyzed may have omitted other potentially statistically significant factors influencing the study conclusions. For example, the study does not analyze or consider in comparisons those members using (versus having) chiropractic benefits. Very definitive comparisons could be made on analysis of overall health expenditures and demographics for managed care members before and after chiropractic benefits become available. Cohorts could be those who choose, and those that do not choose to use the benefit. This way we could better understand an overall increase (or decrease) in cost when the benefit is offered, and what (if any) population would most or least benefit by having coverage for chiropractic care.
In conclusion, I suggest that the limited analysis points, size and demographics used by this study may ignore potential significant factors that contribute to a comparison of costs associated with offering versus not offering a chiropractic benefit.
This argument of a better, cheaper, alternative to expensive knife-dominant allopathic care is the primary Naturopathic Medicine argument (ala NIH studies.) Nice chiropractic spin here.
Point 1 is that it was not the fact that Chiropractic can heal more cheaply than a MD spine-specialist. Self limiting conditions, and that fact that doing something for back pain almost always has better outcomes than doing nothing detracts from this Chiropractic-is-better argument. I propose there may be cheaper, just as effective alternatives to the chiropractic benefits option.
Point 2 this study appears much too broad and variable to draw specific conclusions about the cost versus health benefit of chiropractic primary care. Sweeping extrapolation of data (of the kind that makes a press report) is likely very speculative.
Point 3 is that health insurance actuaries already know exactly how much a chiropractic benefit costs (or reduces costs) in the whole scheme of overall healthcare of the subscriber. Detailed reports are probably proprietary, but we can make observations. Carriers typically limit the chiropractic benefit, either by dollar, or number of visits - hhhm. Health insurers hire health educators to work with employee groups to get subscribers to be more responsible with their own health. They also offer programs not associated with benefits or claims that entail discounts for spas, gyms, and some alternative healthcare. The point being that there may be evidence for better options than Chiropractic primary care benefits.
This type of study needs to be repeated at different managed care co.
The few and rigid parameters of this study in looking only at certain ICD-9 on Chiro vs. MD claims is hugely suspect of leaving important factors about the cost of chiropractic benefit unattended. Given the huge number of claims and disparate factors of the cohorts, I'm thinking that being able to calculate everything to be equal except the chiropractic benefit factor as being close to insurmountable.
This study makes a clinical versus actuarial approach to the data, yet makes a monetary conclusion. The cost of a chiropractic benefit will likely depend on analysis and prediction of what percent of a membership will use the benefit, how many claims the use will generate on average, and the average fee on each claim. This study fails to recognize that an additional benefit means an additional number of claims; or, does not adequately address the difference between added claims, and instead-of-MD claims. When the study compares episodes of care, how do we know that many of the chiropractic episodes were not self-generated due to the existence of the benefit?
In focusing on the existence of a chiropractic benefit, rather than the use of a chiropractic benefit I think this study is too broad and leaves too much open to speculation.
.................
I think there are some important observations about this study that serve to qualify any conclusions that availability of insurance benefits for chiropractic care results in lower medical care costs.
This study looked at claims data on 1.7 million members of a managed care organization over 4 years. It compared total claims data and neuromuscular diagnosis claims data of members with and without a 40 visit/yr chiropractic benefit. It also analyzed claims data for neuromuscular diagnosis for chiropractors and MD’s minus those associated with surgery. Based on analyses of the data, the authors conclude that the existence of chiropractic coverage may reduce overall health care expenditures.
The sheer amount of data within the cohort populations and the "natural" setting of the trial increase the risks for confounding results. There may just be too much data and/or variables to be able to account for all things that might introduce a statistically significant bias within the study.
The study noted a disparity in demographics of the two groups; thus the study analysis had to have this disparity calculated out. It would have been nice had the populations not had such an obvious disparity to begin with. For example, although members with chiropractic coverage had a 12% lower annual medical care cost, this became 1.6% (still statistically significant) when adjusted for demographic differences. That’s quite an amount to be calculated out where a direct measurement of more similar demographics could have eliminated the bias in the first place.
The study concluded that six percent of people with neck and back pain went to a chiropractor versus MD when given the choice. The study does not provide data to compare how close the six percent compared to the total number of members with neck or back pain who saw a chiropractor. That is, if 6% of those with neck or back pain that chose to see a chiropractor instead of an MD is 100 patients, it would be nice to know how many members are seeing a chiropractor for neck or back pain. If that number is 500, where did the other 400 members seeing the chiropractor for neck and back pain come from? One step further, this could make episode of care cost comparison analyses less meaningful if those extra 400 members are included. That is because this represents 400 (more or less) episodes of care that would not have existed had there been no chiropractic benefit. A true episode of care cost analysis would be one made on only those members who are seeing a Chiropractor instead of a MD.
The specific data analyzed may have omitted other potentially statistically significant factors influencing the study conclusions. For example, the study does not analyze or consider in comparisons those members using (versus having) chiropractic benefits. Very definitive comparisons could be made on analysis of overall health expenditures and demographics for managed care members before and after chiropractic benefits become available. Cohorts could be those who choose, and those that do not choose to use the benefit. This way we could better understand an overall increase (or decrease) in cost when the benefit is offered, and what (if any) population would most or least benefit by having coverage for chiropractic care.
In conclusion, I suggest that the limited analysis points, size and demographics used by this study may ignore potential significant factors that contribute to a comparison of costs associated with offering versus not offering a chiropractic benefit.
This argument of a better, cheaper, alternative to expensive knife-dominant allopathic care is the primary Naturopathic Medicine argument (ala NIH studies.) Nice chiropractic spin here.
Point 1 is that it was not the fact that Chiropractic can heal more cheaply than a MD spine-specialist. Self limiting conditions, and that fact that doing something for back pain almost always has better outcomes than doing nothing detracts from this Chiropractic-is-better argument. I propose there may be cheaper, just as effective alternatives to the chiropractic benefits option.
Point 2 this study appears much too broad and variable to draw specific conclusions about the cost versus health benefit of chiropractic primary care. Sweeping extrapolation of data (of the kind that makes a press report) is likely very speculative.
Point 3 is that health insurance actuaries already know exactly how much a chiropractic benefit costs (or reduces costs) in the whole scheme of overall healthcare of the subscriber. Detailed reports are probably proprietary, but we can make observations. Carriers typically limit the chiropractic benefit, either by dollar, or number of visits - hhhm. Health insurers hire health educators to work with employee groups to get subscribers to be more responsible with their own health. They also offer programs not associated with benefits or claims that entail discounts for spas, gyms, and some alternative healthcare. The point being that there may be evidence for better options than Chiropractic primary care benefits.
This type of study needs to be repeated at different managed care co.
The few and rigid parameters of this study in looking only at certain ICD-9 on Chiro vs. MD claims is hugely suspect of leaving important factors about the cost of chiropractic benefit unattended. Given the huge number of claims and disparate factors of the cohorts, I'm thinking that being able to calculate everything to be equal except the chiropractic benefit factor as being close to insurmountable.
This study makes a clinical versus actuarial approach to the data, yet makes a monetary conclusion. The cost of a chiropractic benefit will likely depend on analysis and prediction of what percent of a membership will use the benefit, how many claims the use will generate on average, and the average fee on each claim. This study fails to recognize that an additional benefit means an additional number of claims; or, does not adequately address the difference between added claims, and instead-of-MD claims. When the study compares episodes of care, how do we know that many of the chiropractic episodes were not self-generated due to the existence of the benefit?
In focusing on the existence of a chiropractic benefit, rather than the use of a chiropractic benefit I think this study is too broad and leaves too much open to speculation.
posted by nawledge at
7:56 PM
0 Comments:
Post a Comment
<< Home