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Half a billion wasted on Chiropractic

luchog

Neo-Post-Retro-Revivalist
luchog
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Not sure if this should go here or Current Events.

New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors

Recent Forbes article on just how much money is wasted by the US Government on Chiropractic care. And Chiropractic is not the only sCAM covered; so the wastage is likely even higher.

I particularly like how the author takes a strong evidence-based medicine stance; and flat out calls Chiropractic quackery.

Chiropractors are also lobbying to get it mandated for coverage by private insurance under Obamacare. My state already forces private insurance carriers to cover Chiropractic, Homeopathic, and Naturopathic sCAMs. I'd be interested if anyone knows just how much total government and/or private insurance money is wasted on this crap.

ETA: Looks like Obamacare already covers woo medicine. Great, more wasted money for no improvement. As much as I like the idea of universal healthcare; this is an unfortunately good argument against letting the politicians control it.
http://www.wmbfnews.com/story/20469152/obamacare-to-cover-acupuncture-alternative-medicine
http://www.pbs.org/newshour/rundown...-law-will-impact-alternative-medicine-access/
 
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Thanks for sharing, luchog.

First off, I think what needs to be separated is so-called "legitimate" chiropractic care, namely lower-back stretching and manipulation which is tantamount to what you'd get a physical therapists office. Sure, it's a pig with lipstick, but people do benefit from this kind of chiropractic.

Then, I think you have to look at what the woo-woo part (e.g., treating asthma, diabetes, etc.). The problem, I surmise, is that this is all lumped together in that you can't figure out what the chiropractor is being seen for. One way to determine this would be to look at the ICD-9CM billing codes, which are required for CMS billing, to determine why the patient was seen as the primary diagnosis.

It should be (fairly) easy to determine what ICD-9CM (soon to be ICD-10 in 2015... pushed back another year) would be allowable for billing under CMS regulations. If you are chiropractor, you can only bill for "X" codes, in other words.

The problem is that this is a political nuclear bomb that no one wants to touch. It's not evidence based. The only practical way to solve this is to slightly... ahem... pander to the voting public and allow people to pursue the treatment they want with some restrictions. I absolutely don't feel that we, as taxpayers, should have to pay, for example, a chiropractor to treat someone for food allergies.

~Dr. Imago
 
I used to have two painful problems.

1. A frequently recurring (3-4 times a year) spasm in the neck. It was very painful, and made me unable to turn by head to the right. This spasm would last about a week before diminishing.

2. A severe and constant pain behind my right knee, aggravated if I drove any significant distance, say, for more than about half an hour.

On a doctor's recommendation I went to physiotherapy, having session after session. I tried three different physios. The symptoms would alleviate for a time, then they would come back. This went on for over three years. I tried an osteopath, deep tissue massage, and in desperation, I even went to an acupuncturist. :eye-poppi

Then one of my staff recommended a chiropractor that she uses. After just three sessions over three weeks on the chiropractor's table; the knee pain was gone and the neck spasm has not recurred. That was nearly 10 years ago. I have only been back a couple of times since and for different problems, collapsed metatarsals in each foot (fixed)

I don't consider any of the money I have spent on chiropractic "wasted"
 
smartcooky said:
I don't consider any of the money I have spent on chiropractic "wasted"
Click to expand...

You're fortunate in several regards. First, you found somebody who could help you. Second, you found somebody who didn't hurt you. Third, I sincerely hope, you didn't get somebody that isn't trying to bleed you, or your insurance company. As a claim handler for a "Large US Auto Insurance Company", I saw people who couldn't answer yes to even one of those three.

As for "benign" chiropractic, they're just PT without proper training.
 
Dr. Imago said:
First off, I think what needs to be separated is so-called "legitimate" chiropractic care, namely lower-back stretching and manipulation which is tantamount to what you'd get a physical therapists office. Sure, it's a pig with lipstick, but people do benefit from this kind of chiropractic.
Click to expand...

I think it's worse than lipstick on a pig; since giving them money at all legitimizes the whole chiropractic industry. If the only legitimate treatment they provide is the same as an evidence-based physical therapist, or massage therapist, then there's absolutely no reason to allow chiropractors to get any public funding at all; particularly since it's nearly impossible to separate the small amount of legit stuff from the mountain of woo. Its minimally effective at best; and lethally dangerous at worst. A waste of money that would be better spent on evidence-based therapy and research. Can you imagine what an extra half-billion a year could mean to medicare patients who have legitimate illnesses and need to see expensive specialists, or need expensive, non-generic medicines; both of which are extremely difficult, if not impossible to get. Hell, just the ability to provide decent dental treatment would grow immensely more than the current dismal state.
 
Daylightstar said:
With which chiropractic principles does this lower-back stretching and manipulation agree?
Click to expand...

Stretching and massage are just as much a part of chiropractic treatment as manipulation; and are the only part that is in any way legitimate. They're also typically available from more legitimate providers, often cheaper.
 
luchog said:
I think it's worse than lipstick on a pig; since giving them money at all legitimizes the whole chiropractic industry. If the only legitimate treatment they provide is the same as an evidence-based physical therapist, or massage therapist, then there's absolutely no reason to allow chiropractors to get any public funding at all; particularly since it's nearly impossible to separate the small amount of legit stuff from the mountain of woo. Its minimally effective at best; and lethally dangerous at worst. A waste of money that would be better spent on evidence-based therapy and research. Can you imagine what an extra half-billion a year could mean to medicare patients who have legitimate illnesses and need to see expensive specialists, or need expensive, non-generic medicines; both of which are extremely difficult, if not impossible to get. Hell, just the ability to provide decent dental treatment would grow immensely more than the current dismal state.
Click to expand...

I'm not disagreeing with you. I was just trying to frame it in a larger sociopolitical context. It's the third rail.

~Dr. Imago
 
luchog said:
Daylightstar said:
With which chiropractic principles does this lower-back stretching and manipulation agree?
Click to expand...
Stretching and massage are just as much a part of chiropractic treatment as manipulation; and are the only part that is in any way legitimate. They're also typically available from more legitimate providers, often cheaper.
Click to expand...


Part of the 'treatment' .... right. That's not what I asked.
With which chiropractic principles are this lower-back stretching and manipulation in accordance?

Or in other words, how is such stretching/massaging specific to chiropractic?
 
luchog said:
New Medicare Data Reveal Startling $496 Million Wasted On Chiropractors

Recent Forbes article on just how much money is wasted by the US Government on Chiropractic care. And Chiropractic is not the only sCAM covered; so the wastage is likely even higher.

I particularly like how the author takes a strong evidence-based medicine stance; and flat out calls Chiropractic quackery.

Chiropractors are also lobbying to get it mandated for coverage by private insurance under Obamacare.
Click to expand...


The fall out from the Forbes article has been written up here:
http://doubtfulnews.com/2014/04/sub...pine-out-of-place-over-chiropractic-critique/

The International Chiropractors Association responded to it through legal counsel. Paging Simon Singh...
 
Blue Wode said:
The fall out from the Forbes article has been written up here:
http://doubtfulnews.com/2014/04/sub...pine-out-of-place-over-chiropractic-critique/

The International Chiropractors Association responded to it through legal counsel. Paging Simon Singh...
Click to expand...

I'd love to see their claims tested in court; where they would actually have to provide "put up or shut up" evidence. Unfortunately, that's unlikely to happen in the US, there are plenty of ways they can weasel around it.
 
I think, again, there is some possibility of pursuing this WRT claims of treating certain chronic health conditions not related to lower back pain. That's why I suggested limiting CPT and ICD-9 codes to what can be billed.

I'm not advocating for chiropractic, so don't misread what I'm saying. Quite the contrary, as it can be downright dangerous to try to treat, for example, asthma with manipulations alone.

But, to reiterate, I think a lot of politicians are going to be loath to touch this with a ten-meter stick. The reason? A lot of their constituents current get their treatments paid for through Medicare/Medicaid and, at least anecdotally, they feel they benefit from them whether or not they actually do. It's harder to take something away than it is to give it in the first place.

The problem with sunshine is that it illuminates everything. We've stumbled into a political hot potato here that no one wants to touch. My suspicion? Pursuing this full-bore and demanding defunding will backfire. That's why compromise (i.e., paying for lower back adjustments and nothing else) seems like the only politically viable solution. If you take the all-or-none stance, the "all" is going to win.

~Dr. Imago
 
smartcooky said:
I used to have two painful problems.

1. A frequently recurring (3-4 times a year) spasm in the neck. It was very painful, and made me unable to turn by head to the right. This spasm would last about a week before diminishing.

2. A severe and constant pain behind my right knee, aggravated if I drove any significant distance, say, for more than about half an hour.

On a doctor's recommendation I went to physiotherapy, having session after session. I tried three different physios. The symptoms would alleviate for a time, then they would come back. This went on for over three years. I tried an osteopath, deep tissue massage, and in desperation, I even went to an acupuncturist. :eye-poppi

Then one of my staff recommended a chiropractor that she uses. After just three sessions over three weeks on the chiropractor's table; the knee pain was gone and the neck spasm has not recurred. That was nearly 10 years ago. I have only been back a couple of times since and for different problems, collapsed metatarsals in each foot (fixed)

I don't consider any of the money I have spent on chiropractic "wasted"
Click to expand...

People have also argued that paying for a placebo is not a waste of money either--if it 'cures' you, who cares how the cure is effected? Not sure I buy that argument. Bottom line is that you really have no way of knowing whether it was the chiropractic that cured you. Muscular/tissue pain is notoriously fleeting, subjective, and highly tied to one's psyche. You also have no way of knowing whether the pain would have gone away without the chiropractic. The only thing that can make those sort of determinations is controlled tests--and unfortunately pain is so subjective that testing can be a difficult process.
 
Dr. Imago said:
I think, again, there is some possibility of pursuing this WRT claims of treating certain chronic health conditions not related to lower back pain. That's why I suggested limiting CPT and ICD-9 codes to what can be billed.
Click to expand...
As an aside, arguing with the use of very profession-specific jargon does little to advance your case. /nitpick
 
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