Needless to say, I was flabbergasted at the headline, "Putting Spine Care in the Right Hands," touting Optum's plan to increase consumer utilization of conservative care for back pain [March 2019 feature story; click here to read]. If anything, Optum has done everything it can to decrease the accessibility of chiropractic to the consumer.
First of all, Optum insults chiropractors by paying a global fee of $55 no matter what you do. I do an exam that is far better than any exam a patient would get at a medical doctor's office, yet I get a maximum reimbursement of $55. If I also do an adjustment and/or therapy, my maximum reimbursement is still $55. If I also teach the patient how to take care of their back, my maximum reimbursement is still only $55.
Which brings me to the my second concern: Optum bases how much care a patient can get on what is entered into the submission form online. It hardly matters how severe the person's condition is or extenuating factors such as obesity. A doctor in Minnesota who has never talked to, seen or touched my patient decides how much care they can get. Usually it's barely enough to get them out of pain and it's never enough to get them well. If I ask for more visits, I run the risk of getting booted from the network.
Therefore, with Optum-restricted access to care by limiting the number of visits and restricting the amount and/or quality of care by subjecting chiropractors to a global fee, I fail to see how it could be focused on improving access to conservative care for low back pain patients.
Susan Sykes, DC Clemmons, N.C.
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