Manitoba is the only remaining Canadian province that covers a portion of chiropractic care for all residents, but a new funding formula effective June 1 cuts $4.8 million from Manitoba Health's annual subsidies for chiropractic, reduces the allowable number of visits to a DC from 12 to seven per year, and lowers the per-visit coverage amount from $12.30 to $8.29. (On April 1, 2018, coverage will increase to $10 per visit, but still significantly lower than previously.)
Note that this coverage amount is for the chiropractic adjustment only, according to the Manitoba Chiropractors Association (MCA), and "does not include other services such as the examination, re-examination, x-rays, consultation, general information on exercises or nutrition, or other therapies used to support the chiropractic adjustment."
In an article in the Canadian Chiropractor reporting on the cuts, Dr. Greg Stewart, a spokesperson for the MCA, emphasized the funding scale-back "flies in the face of the national opioid strategy. ... Although we have the provincial government signing on to the federal government's national opioid strategy about improving access to nonpharmacological care, at the same time within months of each other, they decrease access for the same nonpharmacological care. It's hard to understand."
Longtime readers of Dynamic Chiropractic will recall that Ontario delisted chiropractic as a partially covered service in 2004, and Alberta followed suit in 2009, leaving Manitoba as the sole Canadian province offering any measure of chiropractic coverage for all residents. One wonders whether the provincial government's next cost-saving step will be to remove chiropractic entirely from Manitoba Health. Stay tuned.
MRI is currently the gold standard for identifying radicular pathology, but unfortunately, it requires preauthorization, which isn’t easy to obtain. Physical tests are what most practitioners depend on – despite the marginal reliability of the tests. The information in this article brings history and observation to the forefront of radicular diagnostics. Each factor listed can significantly increase the clinician’s ability to diagnose radiculopathies.
With some plans – and it starts with Medicare (CMS) – there is a payment protocol called the multiple-procedure payment reduction (MPPR). This protocol means that if a health care provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for onlythe highest-valued procedure. The subsequent procedures will be reduced, as there is overlap.
A 42-year-old male former patient arrives at your chiropractic office with excruciating low back pain that travels all the way down his right leg to his foot. A spinal surgeon previously recommended surgery to correct an MRI-confirmed disc herniation (sequestration) at L5, but the patient chose conservative chiropractic care. Although conservative treatment is effective for many lumbar disc herniations, the warning signs in this case call for escalation.
