Chiropractors as Primary Care Providers

Dynamic Chiropractic, Jun 4, 2007 by Vivo, Meghan

Update to 2004 study shows continued low utilization costs and high patient satisfaction rates.

The latest issue of the Journal of Manipulative and Physiological Therapeutics features an update to Sarnat and Winterstein's 2004 research paper that assessed chiropractors' effectiveness as primary care providers (PCPs). As with the 2004 report, the latest research concludes that a managed care network with chiropractic gatekeepers saves substantial costs and results in decreased utilization as compared to PCPs using conventional medicine alone.

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

The original report1 analyzed utilization data from 1999 to 2002; the updated report provides similar data from 2003 to 2005. The basic idea behind the chiropractic PCP model was to create an integrative system of health care using PCPs who specialized in nonpharmaceutical and nonsurgical approaches, and to compare patient and provider data with the traditional HMO system. An independent provider association (IPA), known as Alternative Medicine Integration Group (AMI), served as the integrative health care system and operated within the standard HMO model.

The recent analysis2 supports the original finding that patients enrolled in the chiropractic network experienced fewer hospital visits, spent less time in the hospital for care, underwent fewer surgeries and used far fewer pharmaceuticals than other HMO patients who received traditional medical care, resulting in low utilization costs and high patient satisfaction scores. Moreover, chiropractors succeeded in diagnosing and treating patients at a level nearly equal to medical doctors.

In 1999, at the start of the initial study, enrollment included only 37 members. By 2002, enrollment had increased to 649 members. In the updated report, enrollment had more than doubled, without employing any marketing incentives to attract potential patients to the IPA. Study participants originated from an open enrollment offered to all of the HMO's members in metropolitan Chicago. One notable difference between the 2004 report and the 2007 report is that the recent IPA panel of PCPs included not only doctors of chiropractic, but also "CAM-oriented medical doctors and osteopathic doctors." Of significant interest to the study authors was whether expanding the panel would affect utilization, particularly considering enrollment size.

AMI contracted with the same DCs for both studies, each of whom specialized in nonpharmaceutical and nonsurgical approaches and underwent credentialing processes that exceed the existing National Committee for Quality Assurance requirements for CAM providers. The recent IPA panel consisted of 14 doctors of chiropractic and seven CAM-oriented medical doctors/DOs. As in the previous report, AMI's medical directors acted as the integrative link to conventional medical referrals and inpatient health care utilization, and provided medical management oversight.

Utilization and Costs: A Continuing Trend

For the entire seven-year study period (1999-2005), AMI's members (70,274 total membermonths) had 60% fewer hospitalizations, 62% fewer outpatient surgical cases and 85% lower pharmaceutical costs than HMO members. With such low utilization rates, AMI's resulting health care costs were well below the amounts predicted for all seven study years. The fact that utilization rates were low during all seven years "gives credence to the argument that the power to achieve reduced utilization is due to the underlying philosophy of medical management and not due to differences in PCP education or licensure," according to the study's authors.

The updated report continues to suggest that chiropractors are well-suited to act as PCPs. As was the case in 2001, chiropractors in 2005 were able to manage 60% of their patients without requiring a referral to a conventional medical specialist. DOs efficiently fulfilled their primary care duties as well, managing 91% of their patients without a referral. "It is unfortunate that other variables in member utilization, aside from referral patterns, cannot be compared between the PCPs of different licensure," noted the study authors. "The overall model of medical management is so integrated among the PCP panel that it would be misleading to artificially separate and analyze any other utilization data."

Quality of Care, Satisfaction Remain High

Although patient survey response rates varied, members enrolled in 2003, 2004 and 2005 reported being highly satisfied with the chiropractic quality of care (96%, 94% and 91% satisfaction rates, respectively). This trend also can be seen in the data from 19992002 (100%, 89%, 91% and 90% satisfaction rates, respectively). As compared to HMO satisfaction rates, which were not disclosed, the AMI members "consistently rated their experience more positively than the conventional medical IPA network average."

Based on an analysis of 50 questions on the annual member survey, the AMI IPA received "blue ribbon status" from the HMO's independent quality control division each of its seven years in existence. With annual audit scores between 97% and 100% from 2002-2005, the IPA far exceeded the HMO required score of 90%.

Featured Download

Speak Like a CEO

Health Care Industry

Chiropractors as Primary Care Providers

Dynamic Chiropractic, Jun 4, 2007 by Vivo, Meghan

Find Research Guides for:

Find Featured Titles for: News

Most Popular Articles in Health

Most Popular Publications in Health