The study, “Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey,” appeared in the June 2014 issue of the Journal of Occupational and Environmental Medicine. It examined the total direct (medical, pharmaceutical) and indirect (lost productivity, absenteeism, workers compensation, short- and long-term disability) cost outcomes associated with care for back problems reported by workers at a major self-insured heavy manufacturer in the U.S.
Over a third of the 21,080 employees tracked from 2001 to 2009 reported one or more back problems. The analyses identified five treatment approaches based on the first six weeks of claims and used published guidelines to focus on the 10,406 low back pain episodes reported across the nine-year study period.
Lead author Harris Allen PhD said: “Care congruent with 10 of the 11 guidelines we tested was linked to lower total costs. Of the five approaches, which ranged from complex medical management to information and advice, employee patients in the chiropractic group were the least likely to use any of the five most frequently prescribed classes of medications, to receive medically intensive procedures like surgeries, and to record guideline-incongruent use of imaging, medications and procedures when the latter were delivered. They also averaged significantly lower total costs per episode, even when statistical adjustments were made to improve group comparability.”
The overall results added to the growing body of research that supports the proposition that good health care is good value. Yet, in some cases, cheaper care was not necessarily the better value, as was shown when chiropractor and physical therapist visits were further analyzed, the study said. Continued Allen: “The 11th guideline we assessed was interpreted to recommend that the first visit to a chiropractor or physical therapist takes place after a two-week waiting period. Yet, we found that when this first visit to either type of provider occurred before the two-week mark, total costs were reduced. Adjusted, the estimates ranged from approximately $2,200 to $1,200 less than the overall average across years one, two and three per episode for neurological diagnoses to approximately $1,100 to $200 less across years one, two and three per episode for non-neurological diagnoses.”
While more research is needed, these findings indicate that delaying chiropractic care, although cheaper upfront, is likely to be linked to higher total costs over the long term.
When asked as an expert external to the project team for his assessment, Paul Papanek, MD, MPH, FACOEM, Speaker of the House of Delegates for the American College of Occupational and Environmental Medicine and seasoned clinician in the treatment of employee low back pain, concludes: “This paper makes a significant contribution, and demonstrates that, by focusing on adherence to quality guidelines for low back care, company health plans and providers will see better outcomes and lower costs.”