Chiropractic in Worker's Comp: Respect (At Last)

The Workers Compensation Research Institute's recent report on Chiropractic Care for Workers With Low Back Pain reveals a number of important factors relating to the use of chiropractic for LBP in physical medicine within worker's comp in 28 states.¹

Significant Benefits

Compared to non-chiropractic care for pain management, chiropractic-only care and E&M resulted in:

• 47% lower treatment costs per claim
• 35% lower indemnity payments
• 26% shorter disability periods
• 79% less paid for non-pain-management medical services
• Much lower use of opioid prescriptions, MRI and pain management injections

In addition, for pain management only, for which medical doctors co-managed patient care, chiropractic care (compared to non-chiropractic care) resulted in:

• Similar treatment costs per claim
• 17% lower indemnity payments
• 17% shorter disability periods
• Lower use of opioid prescriptions, MRI and pain management injections

Utilization Patterns & Prevalence

Looking at chiropractic utilization, the study divided the 28 states into three groups: employer control of selection of providers, employee limited choice of providers and employee choice of providers. Eleven of the 16 employer control states experienced chiropractic utilization at less than 5 percent: Arkansas, Florida, Georgia, Indiana, Missouri, Nevada, New Jersey, North Carolina, South Carolina, Tennessee and Virginia. The highest utilization among the employer control states was 11 percent for both Iowa and Pennsylvania.

Chiropractic utilization among the six limited employee choice states ranged from 7 percent (Kentucky) to 34 percent (Minnesota). Interestingly, utilization in the six employee choice states was lower, ranging from 2 percent (Michigan) to 28 percent (Wisconsin).

But there are other factors that also may contribute to the variation among the states included in the study. While the number of DCs in a state seems to be correlated with the use of chiropractic care in several states with greater chiropractic usage, for most states there was little correlation. The investigators "believe that provider choice policies and the general perception of the cost-effectiveness of chiropractic care are the most important factors explaining the large interstate variation in the use of chiropractic care."

An Elephant in the Room

Sadly, when looking at the pain management portion of physical medicine, chiropractic-exclusive care only accounted for 12 percent of the total, with combined care adding another 13 percent. Almost three-quarters of physical medicine care (71 percent) is provided by non-chiropractors, the majority of whom are physical therapists. Among the states included in the study, Texas had the lowest level of chiropractic pain management care (7 percent); Minnesota had the highest (59 percent).

Implications for Policymakers

In a recent webinar discussing the report, investigators Dongchun Wang, Kathryn Mueller, MD, Donald Murphy, DC, and Randall Lea, MD, explained their findings, adding important insight to the report. Dr. Mueller, former medical director for the Division of Workers' Compensation in Colorado, looked at implications of their findings for policymakers. She emphasized the potential savings chiropractic care can provide worker's compensation programs. She specifically compared chiropractic pain management with medical pain management, noting that the mean visits were similar (11.4 vs. 9.4), median visits were also similar (seven vs. six), but that chiropractors showed an impressive difference with fewer MRIs and less opioid use.

She also noted that should a state provide open access to chiropractic care, it could expect patients to choose chiropractic who are:

• Less likely to have neurologic-related complaints
• Less likely to have medical comorbidities
• Less likely to have attorney involvement
• Less likely to have more than seven days of lost time
• More likely to be living in rural areas
• Somewhat more likely to be female and working in clerical / professional positions

To assist policymakers in their effort to improve care, the study provides a statistical appendix with important data comparing the experiences in the 28 states. The investigators believe their study "contributes to a better understanding of chiropractic care in workers' compensation. The results are useful for policymakers and stakeholders who are interested in improving the delivery of workers' compensation health care."

Editor's Note: This study should be shared with all work comp policymakers, particularly in states in which employers still control provider selection.

References

1. Mueller KL, Wang D, Lea RD, Murphy DR. Chiropractic Care for Workers With Low Back Pain. Workers Compensation Research Institute, May 2022. Read Here
2. Webinar on Patterns and Outcomes of Chiropractic Care. Workers Compensation Research Institute, June 15, 2022.