MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Chiropractors (and other alternative practitioners) tend to treat their patients for unnecessarily long periods of time. This, of course, costs money, and even if the treatment in question ever was indicated (which, according to the best evidence, is more than doubtful), this phenomenon would significantly inflate healthcare expenditure.

This sounds perfectly logical to me, but is there any evidence for it? Yes, there is!

The WSJ recently reported that over 80% of the money that Medicare paid to US chiropractors in 2013 went for medically unnecessary procedures. The federal insurance program for senior citizens spent roughly $359 million on unnecessary chiropractic care that year, a review by the Department of Health and Human Services’ Office of Inspector General (OIG) found.

The OIG report was based on a random sample of Medicare spending for 105 chiropractic services in 2013. It included bills submitted to CMS through June 2014. Medicare audit contractors reviewed medical records for patients to determine whether treatment was medically necessary. The OIG called on the Centers for Medicare and Medicaid Services (CMS) to tighten oversight of the payments, noting its analysis was one of several in recent years to find questionable Medicare spending on chiropractic care. “Unless CMS implements strong controls, it is likely to continue to make improper payments to chiropractors,” the OIG said.

Medicare should determine whether there should be a cut-off in visits, the OIG said. Medicare does not pay for “supportive” care, or maintenance therapy. Patients who received more than a dozen treatments are more likely to get medically unnecessary care, the OIG found, and all chiropractic care after the first 30 treatment sessions was unnecessary, the review found. However, a spokesperson for US chiropractors disagreed: “Every patient is different,” he said. “Some patients may require two visits; some may require more.”

I have repeatedly written about the fact that chiropractic is not nearly as cost-effective as chiropractors want us to believe (see for instance here and here). It seems that this evidence is being systematically ignored by them; in fact, the evidence gets in the way of their aim – which often is not to help patients but to maximise their cash-flow.

13 Responses to Most (if not all) of the money spent on chiropractic is wasted

  • Medicare defines medically unnecessary care as that in which documentation does not blatantly show improvement in function. If a wheelchair-patient has significant pain which is relieved via chiropractic intervention, yet doesn’t significantly improve/increase his ADL’s, Medicare claims it is unnecessary per its audits. Most of these findings are challenged and won by chiros since auditors search for any fault in doctors’ record-keeping to take back already paid funds. When the necessity for care is explained, the take-back prosecution ceases. Medicare’s auditing practices have forced the chiros to change the way they document necessary care so that it doesn’t appear to be unnecessary; fortunately, Medicare has provided seminars which evince what its auditors deem to be appropriate documentation of medically necessary care. Medicare’s audits increased in frequency when President Obama orchestrated a raid of over .7 billion dollars from Medicare to pay for the now-imploding Obamacare. Medicare now does the same for doctors who perform angioplasties, stents, spinal fusions, etc.; the audits are initially computer-driven and it is these computer-driven findings which are reported by OIG.

    Edzard doubts the cost-effectiveness of chiro services vis a vis Medicare. Hmmmm……Medicare pays approximately $18-22 per visit for chiro care. 12 visits cost the system $264 max(about the price of two visits to a GP for costly RX’s which would add to the expenditure) and usually don’t result in costly referrals for unnecessary imaging or specialist referrals. It’s unfortunate that Edzard speaks about American chiro issues as though he actually knows much about them(hint: his risible, usually bodacious, attempts to to feign such knowledge makes me giggle every day).

  • ‘Medicine’, of whatever description, has many faults. Practitioners, of whatever description, many be motivated by the purest principles of altruism and genuine concern for their patients. But some, of whatever description, may be too easily led into the paths of quackery, deception, corruption and fraud.

    Historically, some folks decided to take up the conventional ‘medicine’ of their day. Some folks took up a form of practice described by its originator as being founded on “different principles from that of medicine”. Fair enough.

    There is still no plausible evidence of the ‘vital forces’, or ‘inherent intelligences’ which D D Palmer maintained could be freed by ‘adjusting’ ‘subluxations’ – and which have never been identified by anyone other than a believer in the faith promulgated by his acolytes. It is quite remarkable that funds allocated in the American system for modern medical care are used for support of a faith, and for payment of those acolytes.

    Evidence-based science, medicine, and healthcare rationing policies can be the only answer to finding a rational and fair way forward for healthcare funding. That is why such an approach is referred to as ‘mainstream’. Those floundering on the shoals and in the rapids should make the effort to join the mainstream. They will be welcome. And will find enough eddies and branches to satisfy their interest and intuition for innovation.

    • Dick is at it again: lobbing drivel into this conversation about the formative years of chiropractic as though it relates to its modern-day practice. Perhaps Dick would condemn “modern medicine” for its brilliant use of leeches and bloodletting to treat conditions such as UTI’s during its early years? Of course he wouldn’t, because to do so would be akin to a self-inflicted wound to his anti-chiro meta-narrative. Most of Dick’s comments regarding chiro belie virtaully any understanding of how its practiced by the majority of the profession in the USA.

      Now, Dick, know that I agree with you regarding the preposterous notion of the freeing of vital forces via subluxation adjustment; I’ve never used such jargon in my practice. However, I don’t find it “quite remarkable” that payment for medical services for committed drones of a medical profession which, in the past, proferred thalidamide for morning sickness and performed bloodletting ceremonies for various health problems wold be justified. Why? Simply because professions can grow from humble, perhaps unfounded, philosophies into more scientifically sound enterprises.

      • enterprise indeed!
        but not a responsible healthcare profession.

      • “professions can grow from humble, perhaps unfounded, philosophies into more scientifically sound enterprises”

        They can, when their underpinnings are validated by science and have a rational basis. Chiropractic, as described in textbooks and papers has never been validated scientifically and the VSL has never been shown to exist other than in the imaginations of chiropractors.

        If you don’t talk in terms of the vital force or the VSL in your practice can you please say what is it you do then – is there another way chiropractic claims to work?

        Niall

        • It appears that some chiropractors have attempted to copy techniques of Physical Therapy but unfortunately add a great deal of nonsense and unproven magic to their tricks, especially when they advertise gimmicks that other alternatives espouse(Naturopaths).

          • @ Cox

            “Copy techniquess of PT’s”? Get a clue! Medical and rehab science is not exclusive to any singular profession. Chiros have been advocating specific rehab techniques since long before I became licensed over 30 years ago. I have attended copious DC-taught and PT-taught rehab seminars and they are basically the same.

            My PT experience and knowledge are quite unique since I’ve been married to a PT(senior therapist at a quite large medical center) for nearly 30 years. Your nasty, ignorant missive regarding “copying technique” of PT’s is chimerical and exposes you as quite the dullard relative to chiropractice. Perhaps you should stick to commenting within the paramenters of whatever expertise you have. You will likely appear at least semi-cogent.

            Be well, Cox

          • Logos, your response is pitiful. You do nothing beneficial beyond the services your PT wife performs. Why do you and your colleagues claim to cure so many unrelated disorders and symptoms with your magic adjustments?

        • Chiropractic SMT is but one part of a DC’s armamentarium when treating mechanical spinal problems. SMT is primarily utilized to restore optimal joint function and is typically used in conjunction with rehab, passive moldalities, lifestyle mods, physiatric injection strategies, etc. Any more questions, Niall?

          • “Chiropractic SMT is but one part of a DC’s armamentarium when treating mechanical spinal problems. SMT is primarily utilized to restore optimal joint function and is typically used in conjunction with rehab, passive moldalities, lifestyle mods, physiatric injection strategies, etc. Any more questions, Niall?”

            So does that mean you do talk in terms of the VSL in your practice then, or are you manipulating spines in a more generic way? I’ve never come across any evidence the VSL has ever been firmly demonstrated on radiographs, CT scans etc and the trials I’ve read comparing chiropractors examining the same patients have found little or no consistency between them. I’d be grateful if you could point me in the right direction.

            Are you of the opinion it is possible to practice chiropractic without reference to the VSL – I had believed correcting the VSL was pretty much what chiropractors do. Am I wrong – is there is another definition of chiropractic that doesn’t include the VSL that you could explain to me?

            I think the rehab and lifestyle advice is great, I’m just a bit confused about where the VSL fits – if at all.

            Niall

        • Niall

          Please define VSL. I will then hopefully be able to answer your question.

      • @ Logos-Bios on Saturday 22 October 2016 at 12:38

        “Perhaps Dick would condemn “modern medicine” for its brilliant use of leeches and bloodletting to treat conditions such as UTI’s during its early years?”

        I can’t see why he wouldn’t. Bloodletting was tested during the American civil war and discarded not long after because of scientific testing; about 30 years before your form of witchcraft was invented by a convicted conman.

        Come on LB, post your website URL so we can all see what dubious nonsense you get up to.

        • Frank,

          You’re rambling again. At least you admit that “modern medicine” did in fact engage in spurious treatments in its earlier stages of development. I’m glad to learn that you have the deductive powers of at least grade schooler in understanding that professions do evolve.

          Witchcraft, eh? Such a descripitor from an acolyte(er, tool) of “modern medicine,” which killed or deformed more unborn children with its countenancing of thalidomide for the serious pathology of “morning sickness” than chiros could possibly match even if every matient in the world treated repetitively for cervical SMT, is quite ironical. You really should develop some acumen for a topic(mainstream chiropractice) before you proffer your detritus. You will appear less intellectually incapactitated.

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