W hile many injured workers may swear by chiropractors, most employers are more likely to swear at them when they see one listed as a treating physician on a workers compensation claim.
Unchecked chiropractic care can, and often does, drive up the cost of medical care, many employers assert.
But there are times when chiropractic care can actually save employers money in temporary disability costs by returning injured employees to work faster, some workers comp experts say.
The key, they say, is to monitor treatment to ensure that claimants are receiving appropriate care.
In workers comp cases in which chiropractors are the exclusive provider, total costs per claim are 16 percent to 25 percent higher than in cases in which care is directed by physicians, according to a 2002 study by the Boston-based Workers Compensation Research Institute. Medical costs are 17 percent to 21 percent higher in chiropractor-treated cases when considering the costs of complete medical treatment, including physical medicine, radiology, supplies and drugs, the study also found.
"It’s the kiss of death whenever I see a chiropractor on a claim," said Nancy Axtell, director of safety and risk management at PRIDE Industries in Roseville, Calif. PRIDE specializes in placing disabled workers in jobs. "They’ll treat the patient for the rest of their lives."
In fact, Ms. Axtell says she has several claims in which chiropractors have been treating claimants for a year or more after an injury.
"I believe there are some reputable chiropractors out there," she said. "But once they get in the comp system, it’s like giving them an open checkbook."
Ms. Axtell said the situation is particularly acute in California, which recently enacted legislation to limit the number of chiropractic visits workers compensation claim-ants may have.
"In California, employees can sign up to use chiropractors as a comp doctor," she said. Under state law, an employee can predesignate whom he or she would like to have as a treating physician when the individual is injured.
And even in cases where the employee did not predesignate a physician, "the employer has only 30 days of control," she said, after which the injured worker is free to "doctor shop" until finding one he or she likes.
"There are some people who can get better faster with manipulation," observed Dr. Charles Kelley, who heads up the workers compensation program at Outrigger Enterprises Inc. "On the other hand, there are some chiropractors who use long-term manipulation as a therapy, and that just adds to the cost," said Dr. Kelley, who is director of sales-special markets at Outrigger in Honolulu.
"If you have a patient who has an underlying need for attention and medical care and perhaps they have some underlying personality disorder, they can get into the hands of a provider who’s being paid to treat them, and it could go on forever," he said.
But not all chiropractors are bad actors, asserted Tara Schilling, senior vp at Keenan & Associates in Torrance, Calif., a broker that provides third-party administration services for workers compensation.
"Everybody is jaded on chiropractors, and all you’ll hear is horror stories; and there are a lot of them," she said, "but there are chiropractors that help people."
Ms. Schilling cited two "success stories" to support her assertion.
In one, an injured worker who was getting no relief after five weeks of physical therapy was referred to a chiropractor. The chiropractor treated the claimant for two weeks, and the claimant returned to work. The temporary disability savings amounted to $1,508, and avoiding litigation saved the employer an estimated $5,000.
"He was threatening to go to a lawyer," she explained.
In another instance, a claimant seeing an orthopedic specialist whose prescribed treatment included wearing a back brace, medication and physical therapy was referred to a chiropractor.
"He had two adjustments and was back to work the following week," said Ms. Schilling, adding that the temporary disability savings to the employer amounted to approximately $3,500.
"There are clearly subsets of chiropractors out there who are overutilizing, and this overutilization of care, does, in fact, drive up the cost of workers compensation claims," said Dr. David Deitz, national medical director at Liberty Mutual Insurance Co. in Boston. "I think what’s a mistake is to automatically assume that all chiropractors are practicing the same way. There are chiropractors in the United States who practice appropriately and who do good physical med-icine treatments and take good care of claimants."
While moves by states such as California and Florida to limit chiropractic visits may offer a partial solution to the problem, they are not the cure, according to Dr. Deitz.
"It’s a quick fix to a complex problem. It’s certainly worked in Florida, where costs have been reasonably well managed with their regulatory solution," he said.
In Florida, where chiropractic visits were limited by law to 18 visits over eight weeks, medical costs per claim average 20 percent less when chiropractors are directing care than when physicians are in charge, according to the WCRI study.
But the Florida Chiropractic Assn. has since successfully lobbied to raise the limit to 24 visits over 12 weeks.
Perhaps a more effective way to ensure claimants are receiving appropriate chiropractic care is to monitor the treatment, intervening where necessary, and measure outcomes, according to Dr. Deitz.
"When we find that we have people whose treatment plans are off track and are involved with multiple visits and things like that, we try to move those cases not only to case management but, if necessary, to medical peer review, as quickly as we can," he said.
Ms. Schilling concurred.
"As a third-party administrator, what we do is put a nurse case manager on the case," she said. "They facilitate the injured worker’s getting to a permanent and stationary status. And that’s critical, because medical treatment--whether it’s chiro or orthoped--runs rampant."
Using prescreened network chiropractors can also ensure quality treatment, said Fred Scardellette, vp of product development and marketing in disability management at Intracorp in Philadelphia.
"Use of a network can result in unit cost reductions of 10percent to 25 percent," he said. "For best results, a network must include providers of the most-utilized treatments."
Source: Business Insurance magazine.