Abstract
BackgroundModerately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head.MethodsThe demonstration was conducted in 2005–2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework.ResultsExpanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa.ConclusionThe demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.
Highlights
Medicare conducted a payment demonstration for chiropractic services in 2005–2007 that expanded Medicare coverage from “manual manipulation of the spine to correct active subluxations and malfunction” to the full range of diagnostic and treatment procedures for neuromuscular and skeletal (NMS) conditions that chiropractors are trained and legally authorized to perform by the state or jurisdiction in which the treatment is provided
Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period
This report describes the design of the demonstration and its effects on Medicare payments for beneficiaries who were treated for NMS diagnoses in demonstration or matched comparison areas
Summary
Medicare conducted a payment demonstration for chiropractic services in 2005–2007 that expanded Medicare coverage from “manual manipulation of the spine to correct active subluxations and malfunction” to the full range of diagnostic and treatment procedures for neuromuscular and skeletal (NMS) conditions that chiropractors are trained and legally authorized to perform by the state or jurisdiction in which the treatment is provided. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. Medicare currently limits reimbursement to services that involve manipulation of the spine, while commercial insurers and HMOs often provide broader coverage
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