CF 107: Insurance Warming To Chiropractic in 2020 & Chiropractic For Lumbar Herniation and Sciatica
Today we’re going to talk about what to expect with Insurance coverage in 2020 and we’ll talk about some thoughts on chiropractic, lumbar herniation, and sciatica according to what the research tells us.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
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You have collapsed into Episode #107
Now if you missed last week’s episode on joint replacement life spans, spinal infections, and vitamin D w/ calcium supplementation, then make sure you don’t miss that info.
I think there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class won’t you?
On the personal end of things I have to say that this has been one of the more challenging of Christmases if I’m being honest. Beyond the disruption of normal schedules and normal business that goes on with the holidays…..we expect those things. The disruption stinks and it can make us lose money. That is frustrating.
However this one was a bit different for me. If you’re a regular listener then you know that my Dad had a stroke on November 9th so that’s still a daily deal. Going out to the rehab hospital, working with his hand and wrist, elbow, and shoulder to see if I can spark any kind of sensation or movement.
Then on Christmas Eve, my stepdad needs to go to the ER so I drive over to their house and drive my mom and Fred to the VA ER at about 10pm.
Well, we end up sitting there until about 5am. Turns out he has appendicitis but no surgeons until the morning. We had a little time to go home and get a few hours of sleep before having to be back up at the hospital for surgery at about noon on Christmas Day.
So, I got a few hours of sleep in, went by the rehab hospital to check on Dad, went back to pick my mom and family up, then off to the hospital. It only took them about 45 minutes and here’s the amazing thing.
Fred had his appendix out at about 12:45 in the afternoon and was out of the hospital and at his house by 6:30pm.
Outstanding!! And he’s done great. Hell, he said the worst part is where they shaved him and the hairs growing back in are wanting to catch on his clothing. Lol.
So, as you can guess, it was a bit of a miserable Christmas. Back in my rascally days, 5am was nothing to me. In fact, I saw 5:00am pretty regularly after having been up all night hooting and hollering and acting a fool. But at 47, 5:00am is some mystical thing that I only hear about sometimes from my health freak friends that get up to work out in the mornings.
I hope you holidays were more amazing than mine. I hope you got to spend some quality time with your loved ones and I hope the best for all of us in this new year. Upward onward and forward.
Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? I’m about to throw you a deal and if you don’t take advantage of this deal, I just think you might be crazy.
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Our first item of interest today is called “More Payers Backing Chiropractic Care in 2020” by Sherry McAllister(McCallister S 2019). It was published in the Managed Healthcare Executive on December 23, 2019.
Hot potato, coming through….
Just taking this article point by interesting point:
She says research has shown private and government health plans may inadvertently be steering their members toward opioids by not covering, restricting benefits, or charging higher co-pays for chiropractic care.
Indeed and we’ve covered that here as well. This was laid out particularly well in a White House report from 2017 or so I believe. They were actually very clear in pointing out that current Medicare and healthcare policies actually create barriers to conservative management rather than pharmaceutical modalities.
Think about it; when a prescription of opioids cost $10-$20 but a visit to a PT or chiropractor can bust the bank…..well, what you going to pick if you’re not very educated on all of the options available?
She points out a recent study from Boston University showing that patients with a deductible greater than $1500 were less likely to choose a doctor of chiropractic as their entry-point provider.
However, as she points out, United Healthcare has announced a certain employer-sponsored medical plan that will have zero out-of-pocket spending, which will include their deductible….if they opt to go to a chiropractor for treatment of low back pain first. Hell yeah. Hell yeah is what I have to say about that.
We’ve been sitting here at the end of the tunnel waiting on this train that has been delayed for decades. I’m getting old waiting on this stupid POS but it looks like we might be seeing the light coming down the way and hearing the rumbling on the line.
Medical doctors will never lead the charge when it comes to sending these patients to chiropractors. It must come from the payers and maybe we’re starting to see the push. Hell, we know we save the system money so why on Earth would they NOT lead the charge?
UHC estimates that by 2021 this design can reduce imaging by 22%…..good luck getting some chiros to scale back on x-rays UHC….good luck. They estimate it can reduce spinal surgeries by 21%….I’d guess more than that, reduce opioid use by 19%…..more than that I’d guess, and reduce total cost for members and employers. Agreed and agreed.
McAllister goes on to discuss how other healthcare plans are coming on board by expanding or emphasizing coverage in 2020 for chiropractic including Tricare which handles the military folks here in America. Instead of just active duty troops, Tricare is expected to approve extending chiropractic coverage to family members, retirees, and family members!!
Kowapow, people. Sha-freaking-zam to the bamalam.
She points out this is most likely in response to a 10-year study of military members through 3 different clinical trials showing chiropractic was instrumental in increasing strength, endurance, and response time among service members with lower back pain. Again, we have covered these here on The Chiropractic Forward podcast if you’ve been following along.
Chiropractic’s own Dr. Christine Goertz has been instrumental in some of those clinical trials.
Mrs. McAllister points out that even non-military seniors in some part of America could be getting upgraded access to chiropractic through benefit expansions of Medicare Advantage plans.
We know that insurance plans do not like wellness care because they’re stupid and short-sighted but Anthem Blue Cross in California expanded wellness benefits for its Medicare Advantage plans to include up to 24 visits per year with a chiropractor, massage therapist, and/or acupuncturist at no extra cost. Same goes for folks in Philadelphia. Good stuff here people.
When you hear veteran chiropractors such as myself say there’s not been a better time to be a chiropractor in the last 30 years, since the Mercedes 80’s, now you are seeing why. It’s happening before your eyes I believe.
This is all excellent news for chiropractors, massage therapists, and acupuncturists. Now, when can we expect things to really change and translate into more patients in your doors and more money in the bank? Well, who the hell knows? But, I can tell you that the American College of Physicians started recommending spinal manipulation for back pain in 2016, the Journal of the American Medical Association supported that recommendation in a 2017 article, The Lancet’s series on Low Back Pain supported the recommendations in 2017, The White House Report we mentioned backed it all up, Consumer Reports, The Joint Commission, CDC, NIH, and the FDA all came in line with this new thinking.
So, you see the more of these organizations and voices of authority that come on board, the more we’re going to see in our offices. But it is a snowball and the ball has just started rolling at the top of the hill.
The trick is going to be to take advantage of it all by following research and evidence. By expanding and bringing chiropractic closer to the medical community rather than leaving it in some archaic form from 100+ years ago.
Stick with it. It’s moving the right direction and it’s going to be OK.
The second paper is an older one. It’s from way back in 2006. Old man river…. that old man river…
It’s called “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” It was authored by V Santilli et. al. and published in Spine Journal(Santilli V 2006). If it’s in Spine, it’s prolly muy bueno amigo.
Why They Did It
The stated goal here was to assess the short and long-term effects of spinal manipulation on acute back pain and sciatica WITH disc protrusion.
How They Did It
- It was a randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and its suburbs
- They had 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain and/or radiating pain.
- They implemented appropriate outcome measurements
- Manipulations or simulated manipulations were performed five days per week by chiropractors with a number of sessions which depended on pain relief or up to a max of 20
- They used a rapid thrust technique which I’m assuming is high-velocity low amplitude such as diversified
What They Found
- Manipulations appeared more effective on the basis of the percentage of
- pain-free cases
- number of days with pain
- number of days with moderate or severe pain
- Patient receiving manipulations had a lower mean VAS score
- There were no adverse events
Wrap It Up
“Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.”
Our last one today is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” authored by McMorland et al and published in the Journal of Manipulative Physiological Therapeutics in October of 2010. Old man river….not quite that old though. 10 years isn’t fresh in the research world but that’s OK, it’s still a good one we should all know about.
Why They Did It
They wanted to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar herniation
How They Did It
- It was a randomized clinical study
- 120 patients were included all of which were referred by a primary to neurosurgeons for lumbar herniation
- All had unilateral lumbar radiculopathy secondary to lumbar disc her4niation
- The herniations were present at L3/4, L4/5, or L5/S1
What They Found
Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measure
“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.
Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcomes.
Patients with symptomatic lumbar herniation failing medical management should consider spinal manipulation followed by surgery if warranted.
Three syllables….one word, folks. Bamalam. Bam-a-lam, people….
It’s happening. It’s coming. Stay the course, make smart decisions. Be the expert. Use research and the Chiropractic Forward Podcast to do it.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!
Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
McCallister S (2019) “More Payers Backing Chiropractic Care in 2020.” Managed Healthcare Executing.
Santilli V, B. E., Finucci S, (2006). “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” Spine J 6(2): 131-137.