Occupational Back Injury
This past January, the board members of the ICS held a planning session for the ICS. During our time together, many items were discussed, including the “18% by 2018” campaign. If you are not familiar with this campaign, I strongly urge you to visit the ICS website and learn more about this wonderful opportunity to help increase chiropractic utilization by Illinoisans.
At the heart of this campaign is that, as chiropractors, we can help keep patients healthy and reduce health care expenditures. In past articles for the journal, I have presented articles that demonstrate how low back pain care has actually deteriorated in the current health care market due to unnecessary imaging leading to unnecessary services. In this article, I’ll present the evidence from one study that demonstrates the cost savings in occupation-related back injuries when injured workers are seen by a chiropractic physician first.
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The cost of occupational back pain has increased by 65% from 1996 to 2002, with spine surgical procedures representing nearly 21% of these costs. In this study, authors used data from the Washington State Workers’ Compensation Disability Risk Identification Study Cohort (D-RISC), a sample of workers with temporary total disability for a back injury, to assess rates of lumbar spine surgery in the first 3 years of the claim. They aimed to identify early predictors of such surgery, develop a multivariate predictive model of surgery and evaluate the model’s ability to predict surgery.
In the D-RISC, workers with back injuries were identified prospectively through weekly claims review from the Washington State Department of Labor and Industries (DLI) State Fund. Workers who received wage replacement compensation for temporary total disability (4 days off work) due to injury were potentially eligible. 4,354 potential participants were identified, of which 2,147 or 49.3% were enrolled in the D-RISC and completed a phone interview, which was conducted 18 days after claim receipt. Participants were excluded from the D-RISC analysis if they were not eligible for compensation in the claim’s first year, were hospitalized for the initial injury, missing age information or failed to have a back injury according to medical record review. Therefore, 1,885 or 43.3% were included in the D-RISC analysis.
Baseline variables included 3 sources: administrative claims and medical bills data, medical records review, and worker self-report in telephone interviews. The outcome measure was lumbar spine surgery covered by the DLI within 3 years of submission of a new back injury, regardless of the worker’s surgical history. The authors used the computerized DLI medical bill database to identify all surgical CPT® codes paid by the DLI. Surgical procedures were then categorized into fusion, decompression, or both.
Results from the study revealed that most included were non-Hispanic white and male. By 3 years after the claim, 174 of the patients or 9.2% underwent lumbar spine operation. 6 variables from 4 domains contributed independently to the prediction of lumbar spine surgery. Workers who had a high (score of 17 or higher) Roland-Morris Disability Questionnaire (RMDQ) scores had 6 times the odds of surgery compared to those with lower scores. In addition, those with a greater injury severity and who saw a surgeon first had a greater chance of having surgery. Factors that reduced odds of surgery were an age of less than 35, female, Hispanic and seeing a chiropractic physician as the first provider.
In Washington State, like Illinois, the injured worker may choose his or her provider for workers’ compensation treatment. Even after controlling for injury severity and other measures, workers with an initial visit to a surgeon for a work-related injury had almost 9 times the odds of receiving lumbar spine surgery compared to those seeing a primary care provider. Workers who saw the chiropractic physician first had an even lower rate of surgery. The study found that approximately 43% of those patients who saw a surgeon first had surgery within the first 3 years. Of those patients who saw a chiropractic physician first, only 1.5% had surgery. It is interesting to note that the odds of surgery were greatest for those with reflex, sensory and motor abnormalities (32.8%), but they were also high for radicular symptoms without such abnormalities (24.7%).
This study, like many others before it, demonstrates that chiropractic care is not only an efficient model for addressing occupational injuries but also a cost savings tool for employers. By providing evidence such as the information presented in this study, the ICS can encourage employers across the state of Illinois to ensure that chiropractic is included in their benefits packages. After seeing the positive outcomes in their employees, maybe chiropractic physicians could become the portal of entry into the healthcare system for occupational injuries. With solid data to back us up, we should all make it a priority to partner with the ICS and ensure that we hit 18% chiropractic utilization by 2018.
Keeney BJ, Fulton-Kehoe D, Turner JA, et al. Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. Spine 2013 ; 38 : 953 – 964
Editor’s Note: This information is critical on the heels of the massive advertising campaign by the Foundation for Chiropractic Progress in January that pointed patients to www.healthierillinois.com.
