The December 2000 issue of The Back Letter presented an article on a study of treatment costs for low back pain.1 The study included 126,186 members of a "Pittsburgh area health care system" (UPMC), four percent of whom experienced low back pain in the first six months of 1999.
The 4,764 members with low back pain generated the following claims and expenses:
| Expenditure | Number of Claims | Cost |
| Narcotics | 7,49 | $630,000 |
| In-Patient Admissions | 78 | $318,500 |
| MRIs & CT Scans | 1,000 | $348,200* |
| Surgery | 101 | $226,000 |
| NSAIDs | 4,498 | $141,000 |
| Pain X-Rays | 2,279 | $105,000 |
| Physical Therapy | 3,787 | $ 90,042 |
Much to the authors' surprise, narcotics topped the list for expenditures and claims, with an average of one and one-half claims per person at an average of $84 per claim.
In-patient admissions were second at an average of $4,083 for an average 3.4 days of hospitalization ($1,200 per day).
The average cost of surgery was $2,238, not including the surgeon's professional fees.
Members who received physical therapy averaged 10 visits each at an average of $23.77 per claim.
This study should wake up many other health care plans that, like the UPMC health plan, probably don't realize the extent of narcotics being prescribed by medical providers. This awareness should make chiropractic all the more attractive to HMOs, as its care is more cost-effective and has much fewer risks.
Reference
1.Ursiny J, et al. Managing the costs of care for low back pain: experience within a large healthcare delivery system, presented at the annual meeting, American College of Rheumatology, Philadelphia, 2000. Not yet published.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
