Workers' Comp Cost Analysis Flawed in Ohio?
Editor's note: We received this letter in January 2005, in response to an article published in DC in November 2004. We contacted the authors of the original article and requested their response/rebuttal to the following letter; however, as of press time, we have received no response.
To read the original article, please go to www.chiroweb.com/archives/22/25/30.html.
Dear Editor:
In the Nov. 30, 2004 issue of Dynamic Chiropractic, you printed a very authoritative-looking report by Dr. Ryan and Dr. Farabaugh called "Restricting Chiropractic Care Results in Higher Medical Costs." The article by Drs. Ryan and Farabaugh, and whoever "et al." is/are, has given a misleading conclusion concerning costs within the Ohio Bureau of Workers' Compensation (OBWC).
There does appear to have been a 44% jump in medical expenses within the OBWC during the period of 1998 to 2002, but there is no objective evidence that this was from any specific reduction in chiropractic care or by the time-loss claims. The increased expenses were due to a variety of conditions experienced even by hospitals and medical organizations that do not even utilize chiropractic services. Managed care has brought these costs under control, but chiropractic reimbursements have actually gone up since 2000.
The authors of this misleading study suggest that since there was a decrease in the reimbursements for chiropractic services during the phase-in of managed care beginning in 1998, that workers were somehow being discriminated against by the Ohio BWC system and directed away from cost-efficient chiropractic care and into more expensive medical procedures. The costs for medical services and surgical procedures within the OBWC system have gone up, but it is not due to workers not receiving their chiropractic care. Costs for all medical treatment have gone up due to many factors, including prescription costs, hospitalizations, medical inflation and other numerous factors. The authors go on to report that limiting chiropractic treatment results in "abandonment crisis medical coverage"; this is equally erroneous. Look at all the people in this country who do not receive chiropractic treatment. Has their lack of chiropractic care resulted in neglected medical crisis situations?
The conclusion that medical costs within the OBWC have gone up because of reduced chiropractic treatment is irrational and not supported by the authors' observations in the data. There was no statistical analysis performed in this study. The BWC data that was supposedly analyzed wasn't even referenced in their bibliography to verify their observations of the data. They imply that the OBWC is discriminating against chiropractors and forcing them into higher, more costly medical services. This is a slur against the OBWC that is unfounded.
This system has numerous levels of appeal for denied medical treatment of any kind, including chiropractic treatment. Lowered chiropractic reimbursements were the result of proper case management, and addressing overutilized chiropractic services within Ohio's workers' compensation system. Chiropractic usage in a work comp system is not determined by yearly chiropractic reimbursements. Chiropractic usage is more definable as the proportion of injured workers being treated by chiropractors. The yearly expenditures for chiropractic services for Ohio's injured workers do not determine chiropractic usage. There is no relationship of reduced chiropractic reimbursements with higher medical costs in the Ohio work comp system.
In this case, the authors have tried to add two plus two and gotten five. Their observations of the data are flawed and misleading.
Kirk L. Schoenman, DC, DACAN
Columbus, Ohio
Charles Lindquist, DC, DABCN
President, Ohio Society of Chiropractic Physicians
Greenville, Ohio
Locating/Correcting "Intraosseous Restrictions"
Dear Editor:
Are you kidding me? I am compelled to respond to the article by Marc Heller, DC, in the April 9, 2005 issue of Dynamic Chiropractic. Dr. Heller suggests that we can locate and correct "intraosseous restrictions" in the lower extremities. He goes on to say, "Your intention, the question you are asking with your mind/body interface, is to feel for intraosseous restrictions or other lesions within the bones." [Editor's note: Dr. Heller's article, "The Tibia and Femur: Long-Bone Intraosseous Restrictions," is available online at www.chiroweb.com/archives/23/08/06.html.]
This article is both unscientific and unscholarly. To present such a speculative approach under the guise of rational therapeutic intervention is an insult to our profession. His approach belongs within the realm of the metaphysical, and should be presented as such.
John M. Ventura, DC, DABCO
Clinical Instructor,
Dept. of Family Medicine,
University of Rochester School of Medicine
Assistant Clinical Professor, NYCC
Rochester, New York
