The department of Health and Human Services has recently released a new report with a new national strategy to reduce opioid epidemic.
This new report from HHS is enlightening, but the reality is until something is done with the healthcare system as a whole and the fact that opioid pain medications are about the only thing the insurance industry will pay for without limitations, people are going to continue to suffer and die.
Chiropractic Maintenance Therapy Not Covered
To meet Medicare coverage criteria, chiropractic treatment should be aimed at treating acute injuries, re-injuries, or exacerbations. The result of chiropractic manipulations is expected to be an achievable improvement and with a clearly defined end point. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered medically necessary under the Medicare program.
Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition. Therefore, Medicare does not cover maintenance therapy. For additional clarification of the coverage criteria for chiropractic services, refer to your MAC’s Local Medical Review Policy.
Currently when you go to your Doctor of Chiropractic, we must perform a physical examination. Medicare does not pay for this along with almost ALL of the therapies the American College of Physicians recommends:
“For patients with chronic low back pain, ACP recommends that physicians and patients initially select non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”
Our office provides most of the above services yet the ONLY service Medicare and many insurance companies will recognize or approve for payment is SPINAL MANIPULATION. Nothing else on the list of recommended therapies is covered by Medicare or Medicaid along with many other health insurance plans.
The problem with the Medicare policy is that it is not just Medicare. Almost all insurance carriers such as BC/BS and United Healthcare use Medicare guidelines in determining medical necessity. A good example is last year I sat through a webinar put on by Optum Health and United Healthcare that stated if a Chiropractor is used as a portal of entry into the healthcare system for low back pain and treated within the first three days the insurance companies costs on average are decreased by 56%!! This statistic was from the insurance company and their OWN data on low back pain.
Despite this, Optum/UHC continues to be the WORST insurance payor. It has ridiculous pre-cert requirements for care that delay treatment since we cannot treat and examine the patient on the same day. They capitate services which restricts care and the amount of services the patient can have on a given day regardless if it is medically necessary or not!! This is true for both Chiropractic & Rehab services from United Healthcare!
These are only a few small examples. I could go on and on with just about every insurance company and the ridiculous restrictions they have in place. Please keep in mind all of this is to restrict Chiropractic care which is extremely INEXPENSIVE when compared to prescription pain medication and surgery!!! Not to mention the human costs and tragedy from the opioid epidemic which is unmeasurable.
The limitations and caps of both Chiropractic & Rehab are ridiculous, mostly political and greatly increase the use of prescription pain medication. 80% of heroin addicts report that their addiction to heroin started with a prescription pain medication. If the government and insurance industry wanted to have a meaningful impact on the epidemic and healthcare costs as a whole, they could start by allowing people to get alternative treatments other than pain medication and surgery.
The ACP, CDC and now FDA are all recommending alternatives to pain medications.
This argument is nothing new for Chiropractors. HHS and Medicare CMS have had these rules and limitations in place for decades now, and our profession has tried endlessly to change it with all efforts falling on deaf ears. People have to start demanding these services be provided. Patients need to start asking their medical doctors for these services for which many have little to no training in and are not familiar with since most all of these services are NOT offered in hospitals where medical doctors learn and practice their trade.
Most of all, Employers who provide insurance coverage for their employees need to demand better choices and alternative therapies for their health insurance plans. Employers are the largest provider of health insurance in our country and many of them are given a negative view of Chiropractic by the insurance and medical industry. Most people do not realize it is the employers who mostly decide what is and what isn’t covered on an employee’s health insurance plan.
It is astonishing to me that companies such as Wal-Mart and General Motors do not provide any Chiropractic services for their employees. As a matter of fact, Wal-Mart recently released an employee newsletter touting the benefits or surgery for back pain and offering discounts if you go to one of the 6 Wal-Mart back surgery centers! They even cited in the same newsletter that studies show greater than 30% of spine surgeries are unnecessary, although that number is generally found to be anywhere from 50% to 80%. How many of their employees will end up on pain medications as a result of this ridiculous policy, and Wal-Mart is our country’s LARGEST employer!
How can we make a change? It has to come from patients and employers. I am a Chiropractor and obviously me asking for the insurance industry to remove restrictions and pay for more services will largely seem self-serving, and I understand that.
However, I am available to speak to anyone who will listen including medical physicians looking for alternative for their patients, employers or human resource managers who would like more information on what can be done, and of course anyone with a political interest in changing our healthcare system and truly dealing with the opioid epidemic. Please feel free to send me an email if you have an interest in hearing more or having me come to your office or company to present more detailed information.