06/01/2022

Workers Compensation Research Institute: Chiropractic = Lower Costs + Shorter Temporary Disability Times

Michigan: Only 2.1 Percent of LBP Workers’ Comp Claims Received Chiropractic Care in the First 18 Months of Treatment After the Injury

For a quick video from WCRI regarding this report, click here.

In May, the Workers Compensation Research Institute (WCRI) announced the release of a new study on chiropractic care for low back pain. The study reveals substantial variation in the use of chiropractic care across 28 states and offers insights into the patterns and outcomes of chiropractic care.

“This study will be helpful for policymakers and stakeholders who are interested in re-evaluating the role of chiropractors, especially those who have been adopting evidence-based practices and contributing to cost-effective care,”said John Ruser, WCRI’s president and CEO.

In Michigan, WCRI found that the percentage of low-back pain claims that received chiriopractic care (in the first 18 months of treatment after the injury) was only 2.1 percent. In contrast were Minnesota (34 percent), Wisconsin (28 percent), California (25 percent), and New York (20 percent). Overall, 16 of the 28 states studies were between 5 and 34 percent. Ten states had a lower percentage than Michigan, including 1 percent in South Carolina, Georgia, Arkansas, New Jersey, and North Carolina. Of the 28 states studied, the vast majority of states with a low percentage of injured workers who saw a chiropractor were in states in which the employer controls the treatment received.

“Chiropractors often participate in the delivery of physical medicine services for low back pain, but few workers received chiropractic care in states where employers or insurers control the selection of providers,” Ruser said.

In Michigan, under the “28-Day Rule,” the employer controls the injured worker’s medical treatment for the first 28 days of treatment [MCL §418.315(1)]. After the initial 28 days, the employee can choose his or her own provider, but has to notify their employer/insurance company in writing.

The study, Chiropractic Care for Workers with Low Back Pain, describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability. The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections.

Key Findings

Key findings of the study include:

• Claims with care provided exclusively by chiropractors were associated with lower costs and shorter duration of temporary disability than a set of claims with similar characteristics where care was exclusively provided by non-chiropractic providers.
• The prevalence of chiropractic care varied substantially across the 28 study states. States that give employers control of selecting medical providers were among the states with the lowest prevalence of chiropractic care.
• When chiropractors are involved in care, they alone may provide physical medicine care or deliver physical medicine care in conjunction with other non-chiropractic physical medicine providers. Based on the experience of 16 states with prevalent chiropractic care, 12 percent of workers with low back pain received physical medicine care exclusively from chiropractors, and 17 percent received physical medicine treatment from chiropractors and other non-chiropractic providers, concurrently or sequentially.
• The use of opioids, MRI, and pain management injections were lower among the chiropractic-only pain management claims than the matched non-chiropractic-only group.

Chiropractic = Lower Costs

The study found that:

• The average medical cost per claim for low-back pain patients treated exclusively by a chiropractor for both physical medicine and evaluation and management was $1,366, 61 percent less than the treatment cost for cases that received no chiropractic treatment ($3,522).
• Indemnity costs (payments for lost time on the job) were also lower for those who exclusively saw a chiropractor: $492 vs. $3,604 for workers who did not saee a chiropractor.
• For injured workers who received physical medicine services from a chiropractor, but E&M services were conducted by another provider type, medical costs averaged $3,001 (15 percent less than workers who did not receive chiropractic care. Indemnity costs averaged 31 percent less ($2,502 vs. $3,604).

Chiropractic = Back on the Job Faster; Fewer Opioids, MRIs, and Pain Injections

In terms of temporary disability, for low-back pain claims with chiropractic-only physical medicine and E&M services, the number of weeks of temporarty disability was 86 percent lower for claimants who received chiropractic-only physical medicine and E/M services, compared to claims with non-chiropractic-only physical medicine and E/M services (0.7 to 4.9).

Additionally, in compdaring a subset of claims with similar characteristics, the study also showed that:

• Only 1 percent of claimants treated by chiropractors were prescribed opioids (compared to 10.3 percent of injured workers not treated by chiropractors).
• Only 4.3 percent received an MRI, compared to 18.9 percent of non-chiropractic claims.
• Only 0.4 percent received a pain management injection, compared to 6.8 percent.

About the Data

The data used in this study are from the WCRI Detailed Benchmark/Evaluation database, which includes more than 2 million open and closed claims from 28 states, including Michigan. Injuries were sustained over a two-year peiod (October 1, 2015 – September 30, 2017). Medical transactions were tracked thrpough March 31, 2019. Researchers compared costs and claim duration for workers treated exclusively by chiropractors, workers who received no chiropractic care, and workers who received services from chiropractors and other provider types. Claims for serious conditions needing immediate care (tumors, fractures, etc.) were excluded from the data.

About WCRI

The Workers Compensation Research Institute is an independent, not-for-profit research organization based in Massachuisetts. Organized in 1983, WCRI does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the United States, Canada, Australia, and New Zealand.

Sources:

WCRI Press Release, “Chiropractic Care for Workers with Injuries Varied Greatly across 28 States, Finds New WCRI Study,” May 17, 2022

Chiropractic Care for Workers with Low Back Pain. Dongchun Wang, Kathryn L. Mueller, Donald R. Murphy, and Randall D. Lea. May 2022. WC-22-17