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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The proposed merger of the National Board of Chiropractic Examiners and Federation of Chiropractic Licensing Boards was approved by NBCE delegates and FCLB members at their respective annual meetings, held jointly in Atlanta, Ga., this year. Per the new bylaws, the new entity takes the NBCE name, with FCLB continuing as a department within NBCE. The federation will continue to enjoy Board of Directors representation on what will be a single, expanded board.
Before introducing subscapularis syndrome as an upper extremity analog, it is essential to revisit piriformis syndrome as a well-established example of myogenic pseudo-radiculopathy. Piriformis syndrome has long served as a clinical exception to disc-centric models of lower extremity pain and provides an important framework for understanding how deep muscular dysfunction can mimic radiculopathy in the absence of nerve root compression.
Pain has become the dominant language of musculoskeletal healthcare. Numeric pain-rating scales and symptom reports are routinely used as primary indicators of clinical success. But while pain reduction is meaningful, it is an incomplete and often misleading representation of recovery. This has real consequences for patient adherence, long-term outcomes, and how conservative care is perceived within the broader healthcare system.
