Medicaid Pilot Project Demonstrates Efficacy of Chiropractic Care for Chronic Pain

by | Last updated Dec 8, 2023 | Published on Jul 17, 2017 | Specialty Billing

Care Chronic Pain
Share this:

Chiropractic care has earned a leading position as a key option for relief from chronic pain, which in turn, is fuelling the demand for chiropractic medical billing services. In a March 2017 white paper, the Foundation of Chiropractic Progress (F4CP) referred to chiropractic as an important element of the nation’s Opioid Exit Strategy. More and more Americans are choosing this drug-free, non-invasive and cost-effective alternative for acute or chronic neck, back and musculoskeletal pain management.

A unique Rhode Island project involving high-use Medicaid recipients from two health plans demonstrated the efficacy of chiropractic care for chronic pain with significant savings. The key features of the program are:

  • Holistic nurse case management with referrals to complementary and alternative medicine (CAM) providers including chiropractors, massage therapists and acupuncturists
  • Patient education including stress-reduction tips and more

The findings of the Medicaid pilot project were recently presented to the state’s Department of Health, demonstrating excellent outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.

The Advanced Medicine Integration Group (AMI) program was initiated through Rhode Island’s Communities of Care (CoC) program. Under the program, high-risk users (those who had four or more ER visits in the prior 12-month period) were eligible to receive acupuncture, chiropractic, and massage services. The outcomes of the integrated chronic pain program from 2012-2015 areas follows:

  • 27% reduction in per member per year (PMPY) total average medical costs
  • 61% decrease in the average number of ER visits
  • 63% decrease in the number of average total prescriptions
  • 86% decline in the average number of opioid prescriptions
  • Every $1 spent on complementary and alternative medicine (CAM) services and program fees led to medical expense savings of $2.41
  • Patient Satisfaction: According to a third-party survey of program participants, 92 percent “agree or strongly agree their CAM provider reduced their pain level”; 82 percent “believe their quality of life has improved by participating”; and 96 percent “would recommend the program to friends or family suffering from chronic pain or fatigue.”

The holistic nurse care manager played a critical role in the CoC program. Integrative Practitioner reports that AMI’s co-founder Richard Sarnat, MD said:

Chiropractic Care for Chronic Pain“This group of patients is so complex, with all of the bio-psycho-social issues and behavioral health issues, that while it might have been economically attractive to use a less skilled professional, we find the services of the nurses are critical to what we are seeking to accomplish,”… “They protect the quality and safety of the program.”

AMI’s initial integrative primary care pilot project with HMO Illinois also saw positive outcomes, which were twice published in the Journal of Manipulative and Physiological Therapeutics:

  • Hospital admissions decreased by 60 percent
  • Hospital days decreased by 59 percent
  • Outpatient procedures decreased by 62 percent
  • Pharmaceutical costs decreased by 56 percent

AMI is now looking to expand the program in Rhode Island as well as in other states.

Even as chiropractic care finds wider acceptance across the United States, providers need reliable medical billing and coding services. With an experienced chiropractic medical billing company can ensure effective support for filing claims with Medicare and private insurance with the right codes and modifiers. Medicare has many rules and guidelines which determine whether or not chiropractic services will be paid for.

The teams in such companies are also knowledgeable about submission of workers’ compensation and auto accident claims and handling insurance eligibility verification and prior authorizations.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

More from This Author