CF 171: Non-Pharma – This Is The Way & Insurance Coverage Trends
Today we’re going to talk about insurance coverage for complementary care and we’ll talk about non-pharma treatment. This is the way.
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.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
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You have found yourself smack dab in the middle of Episode #171
Now if you missed last week’s episode , we talked about how the medical complex still gets it so wrong when it comes to back pain. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Things are still proceeding at the speed of molasses on the medical integration. I’m afraid that’s going to be a theme going forward for a little bit.
I can tell you that I posted the job with our local Texas Panhandle Nurse Practitioner Association and I posted it on Indeed. I’m getting lots of resumes now too. It’s a little crazy seeing some of these talented individuals. They’re trained in so many things and some are willing to re-locate here from more than 1,500 miles away. It’s a little cool. It’s a little overwhelming.
But I’m stumbling through with the help of my wife and with the help of my buddy. He’s been on this podcast 3-4 times. Most recently on the episode a couple weeks ago when we spoke about the lawsuit we Texas Chiropractors just won over the Texas Medical Association. Dr. Tyce Hergert has been fully integrated for 4-5 years now I believe. He start consulting on integration and that’s who helping guide me through it.
So, at least I’m not trudging through it alone or re-inventing the wheel. I always felt like a mentor or at least a guide was the way to go with anything.
I was doing decent in practice but it wasn’t until I started with a group that provided a network and a mentor for me back around 2011 or so that I really started taking off. I really believe a guide or a mentor is the most reasonable way to go about business of any kind. They shorten the learning curve so much and prevent very costly mistakes.
Just a little tip from your ol’ Uncle Jeffro. You’re welcome.
I’m starting the interviews this week. In fact, I’ve already had one interview. I don’t think she’s right for me. She needs a little more decorum in the place and I like a loose feel so that’s already an alarm that’s going off. Super smart though and willing to learn from a dirty ol’ chiropractor. Lol.
Don’t think I didn’t take the opportunity to tell her about the American College of Physicians and give her the citation for their paper recommending chiropractors. Don’t you think I let that opportunity slip by!!
So I’ve mentioned the voice over thing a few times. It’s been a little nuts. In February I made $2,000 and in March, I’ll probably wrap up the month at around the $1500 mark. That’s $3,500 in two day-um months that I enjoyed doing in my basement and, honestly, it’s low maintenance and I can do the little jobs fairly quickly. It’s amazing.
I’m still working on getting that book I wrote edited. Dr. Chris Howson from the great state of North Dakota, the inventor or the amazing new chiropractic took called Drop Release is editing if for me as we speak. I’ll keep you updated.
Something that is a little different on the personal side of things; I have been coaching my daughter on how to throw the discus. She’s in 7th grade so just learning. I won state in discus and competed in the shot put at state here in Texas. Winning state is a cool part of my past that I’ve always remembered so fondly.
Well, working with her gave me the itch so now I went and bought me my very own man-sized discus and have started throwing again with the thought, or goal, of competing in a master’s tournament sometime in 2022.
It’ll give me a goal to work toward physically. I absolutely love going to throw the discus. If I never actually get the nerve to go compete, I’mm still walking, getting my steps in and getting that exercise.
It’s a win/win. And I looked up the results of the nationals back in 2018. It was held at Easter Washington State in Spokane, Washington and the throws I had after just practicing a little bit for a week would have gotten 4th place so……I think I’m just going to do it. Outside of potential injury, there really are no downsides to it. So, be looking for ol man Uncle Jeffro lobbing a discus around town in a year or so. I tell ya, I have to keep it interesting folks. I have to.
Let’s get to it.
This one is called, “Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments” by Flynn et. al. (1) and was published in American Family Physician on October 15, 2020.
Why They Did It
Here’s what they come out of the gates bucking with:
A chronic musculoskeletal pain disorder is the underlying diagnosis for 70% to 80% of those living with chronic pain.
Among the top 12 causes of disability in the United States, musculoskeletal disorders cause more than one-third of years lived with disability and are among the leading causes of disability worldwide.
Chronic low back pain, neck pain, hip and knee osteoarthritis, and fibromyalgia are the most common types of chronic musculoskeletal pain.
You’ve heard me mention close to a million times about how the American College of Physicians updated their recommendations in 2016. In that recommendation, they set first-line treatment for acute and chronic low back pain. In those recommendations were spinal manipulative therapy, exercise, massage, acupuncture, heat, low level laser, yoga, cognitive behavioral therapy, and tai chi.
Now, this seems to be the similar, and supporting document by the American Family Physicians.
Here is what it says.
Because no individual therapy has consistent benefit, a multimodal treatment approach to chronic musculoskeletal pain is recommended. Many nonpharmacologic, noninvasive treatment approaches yield small to moderate improvement and can be used with pharmacologic or more invasive modalities
- Systematic reviews and guidelines support the effectiveness of various forms of exercise in improving pain and function in patients with chronic pain.
- Spinal manipulation leads to a small benefit for chronic neck and low back pain.
- Cognitive behavior therapy and mindfulness techniques appear to be effective for small to moderate short- and long-term improvement of chronic low back pain.
- Cognitive behavior therapy may also be effective for small short- and intermediate-term improvement of fibromyalgia
- Acupuncture has a small to moderate benefit for low back pain and small benefit for nonpain fibromyalgia symptoms.
- Massage or myofascial release yields a small improvement in low back pain, hip and knee osteoarthritis, and fibromyalgia.
- Low reactive level laser therapy may provide short-term relief of chronic neck and low back pain, and ultrasound may provide short-term pain relief for knee osteoarthritis.
- Multidisciplinary rehabilitation may be effective for short- and at least intermediate-term improvement in pain and function for chronic low back pain and fibromyalgia.
Against a vitalist’s best recommendations, they conclude the abstract with this line, “Patients should be encouraged to engage in a variety of therapies aligned with their preferences and motivation.”
You know….because everyone’s different. Everyone heals differently. Everyone responds to different therapies differently. Not everyone just needs a 30 second adjustment and sent out the door.
All just a part of trying to get our profession to level up. That’s all.
Item number 2 today is called “Trends in Insurance Coverage for Complementary Health Care Services” by Whedon et. Al. (2) and published in the Journal of Alternative and Complementary Medicine on October 8 of 2020 and that’s just hot enough for our favorite soundbite folks.
Why They Did It
Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care services over a 7-year period.
How They Did It
- The authors employed a retrospective serial cross-sectional design to analyze health insurance claims for services provided by licensed acupuncturists, chiropractors, and naturopaths in New Hampshire (NH) from 2011 to 2017.
- They restricted the analyses to claims in nonemergent outpatient settings
- They evaluated by year the likelihood of reimbursement, as compared with primary care physicians as the gold standard.
What They Found
- The total number of clinical services claimed was 26,725 for acupuncture, 8317 for naturopathic medicine, 2,539,144 for chiropractic, and 1,860,271 for primary care.
- Initially, likelihood of reimbursement for naturopathic physicians was higher relative to primary care physicians, but was lower from 2014 onward
- Odds of reimbursement for both acupuncture and chiropractic claims remained lower throughout the study period
- In 2017, as compared with primary care the likelihood of reimbursement was 77% lower for acupuncturists, 72% lower for chiropractors, and 64% lower for naturopaths.
Wrap It Up
The likelihood of reimbursement for complementary health care services is significantly lower than that for primary care physicians in NH. Lack of insurance coverage may result in reduced patient access to such services.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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 rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
At the end of the day, patients should have the guarantee of having the best treatment that offers 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 and tell us your suggestions for future episodes.
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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 – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. Flynn DM. Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments. Am Fam Physician. 2020 Oct 15;102(8):465-477. PMID: 33064421
2. James M. Whedon, Serena Bezdjian, Justin M. Goehl, and Louis A. Kazal.The Journal of Alternative and Complementary Medicine.Oct 2020.966-969.http://doi.org/10.1089/acm.2020.0078