ACA ASSESSMENT PERSPECTIVE:
Alarming double digit increases in health care premiums, averaging a startling 19%, hurt employers, making it nearly impossible to provide comprehensive benefits, and in some cases, any benefits at all to their employees.1 Employees are hurt, too, as they are increasingly receiving skimpier benefit packages and are grappling with penalizing co-pays and deductibles for a health plan, which usually only pays for an acute illness or debilitating injury.
Additionally, the current health care system puts more responsibility on the consumer and the buyer, which has caused more scrutiny of the conventional medical treatment approach in place now. At record numbers, both employers and employees alike are looking for other forms of health care that offer preventive, holistic, non-invasive and drug-free solutions. They want health care that focuses on keeping employees in good health rather than just treating their ill health. Right now, 4 out of 10 Americans use alternative therapies and visits to these doctors already exceed visits to conventional care providers by 65%.2
WORKPLACE INJURY:
Direct medical costs are only part of the problem: loss of productivity exacts an even larger toll, resulting in wasted resources and higher costs. Every occupation puts a unique set of stresses and strain on the body, regardless of whether the employee sits at a desk all day, or is loading and unloading a truck for hours at time. For example, lower back problems alone affect half of all working-age Americans, and are the number one cause of temporary disability in people under age 45.3 Additionally, work-related neuromusculoskeletal disorders represent more than one-third of workers compensation costs and a full one-third of all workday losses.4
Combining these factors brings the total to $60 billion lost dollars each year in direct medical and indirect productivity costs in workers compensation alone. Add to this number, the costs of individual health care services and auto injuries, and the costs soar. This hidden tax on business, its toll on employees and to this country's overall productivity can be dramatically reduced with fundamental changes to the way health care is delivered and paid for.
Severe cost control measures implemented in health care delivery did not fulfill their promise of providing good quality yet cost-effective care. Clearly, choices have to be put in front of policymakers, providers, payers and the public which will create health care intervention at the prevention and wellness stages so low-risk employees do not become high-risk expenditures and, worse yet, become destined to accept outcomes that don't improve their overall health quality.
[1] U.S. Chamber of Commerce, March 15, 1999.
ACA SOLUTION PERSPECTIVE:
Increasingly, payers are looking for favorable patient outcomes rather than just the cost of services as the new barometer for increased quality. Payers now need to offer alternative therapies as a paid insurance benefit rather than a patient paid responsibility. According to a study done by David Eisenberg , MD, which appeared in a recent issue of the Journal of the American Medical Association (JAMA), the top two forms of alternative therapies used by the public are chiropractic (90%) and acupuncture (88%). Additionally, the findings of a recent Mercer Survey show chiropractic is now covered by 80% of HMOs, 91% of point of service and indemnity plans and offered by 95% of employers in a plan choice.5 Coverage is limited, however, in terms of reimbursable services.
Since I am best informed about how chiropractic care has been able to improve outcomes, I will focus solely on this area of alternative health care. Just this week the American Medical News presented chiropractic as a proven health care model and credits doctors of chiropractic with favorable outcomes and being the lowest cost provider of health care for back problems compared to MD's and surgeons.6 Other research consistently shows that:
· Compensation costs are significantly lower for chiropractic care than for medical care.
Medical doctors are not experts in treating the number one reason for injury to employees, and have not effectuated acceptable patient satisfaction levels in restoring neuromusculoskeletal function or eliminating pain for these types of conditions. Their statistics show poorer return to work outcomes for back and neuromuskuloskeletal conditions7-10 and err on the side of over prescribing and medical mistakes often associated with disease management and acute care intervention.
The current health care system needs to allow for better coordinated care between MDs and doctors of chiropractic. All medical doctors need formal medical school education in chiropractic therapies, its referral and intervention points as one strategy to implement true reform. Doctors of chiropractic also need to be included in interdisciplinary teams that center on rehabilitative and chronic pain situations where early patient intervention is critical.
EXPECT BETTER QUALITY AND COST EFFICIENCIES
Employees have a right to expect to get well from most back injuries and other neuromusculoskeletal conditions without having to be hospitalized or receive surgery. They should expect to have early access to doctors of chiropractic who are experts in treating these conditions, and they should have reimbursable insurance coverage for these services since significant research has proven chiropractic to be effective.
Employers can expect to have lower insurance premiums due to cost advantages in chiropractic care, and as Pran Manga, a prominent health economist concludes, the doubling of utilization of chiropractic services from 10% to 20% may realize savings as much as $770 million in direct costs and $3.8 billion in indirect costs.11
Managing health care risk before it becomes unmanageable needs to rank equally as important as other business risks, like shifts in competition and market share. Including insurance reimbursement for treatment protocols that work on getting employees back to work sooner and keeping them there, yet costing less, is a fundamental first step in the right direction. There is no greater measurement of quality than a patient that gets and stays well.
[5] William M. Mercer Incorporated
A RUDIMENTARY SHIFT IN HEALTH CARE DELIVERY AND DEMAND:
[2] Journal of the American Medical Association. November 1998, Trends in Alternative
Medicine Use in the United States. 1990-1997.
[3] Workers Comp Cost Control Report, Sept. 1999.
[4] Facilities Design and Management. Ergonomics. August 1999.
OFFER MORE CHOICES FOR BETTER OUTCOMES
· Hospitalization and medication costs are lower for chiropractic care than for medical care.
· Patients are diagnosed and treated by doctors of chiropractic in less time than by medical doctors.
· Patients treated by doctors of chiropractic lose less time from work than those treated by medical doctors.
[6] American Medical News. January 17, 2000.
[7] Jarvis KB, Phillips RB, Morris EK. Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine 1991; 33(8): 847-852.
[8] Nyiendo J, Lamm L. Disability low back Oregon workers' compensation of claims. Part I: Methodology and clinical categorization of chiropractic and medical cases. Journal of Manipulative and Physiological Therapeutics 1991; 14(3): 177-184, 14(4) 231-239, 14(5) 287-297.
[9] Johnson MR. A comparison of chiropractic, medical and osteopathic care for work-
related sprains/strains. Journal of Manipulative and Physiological Therapeutics 1989; 12(5): 335-344.
[10] Wolk S. An analysis of Florida workers' compensation medical claims for back-related injuries. Journal of the American Chiropractic Association 1988; 27(7): 50-59.
[11] Manga P., Enhanced chiropractic coverage under OHIP as a means for reducing
healthcare costs, attaining better health outcomes and achieving equitable access to
health services. Report to the Ontario Ministry of Health, 1998.
