Chiropractic Letters

Chiropractic Patient Results

In Their Own Words

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Over the decades, millions of patients have experienced what many call miracles, but in fact are simply the results of chiropractic care. Research is starting to catch up with the results of a healing profession that chose not to wait for science to help change the lives of those millions.

The following are a collection of letters from my personal patients, some almost 30 years old and I certify that each letter was written by one of my patients based upon their results under chiropractic care. Although I strongly support other healthcare avenues, none received nutritional therapy, physical therapy, exercise rehabilitation or any care other than chiropractic.

As I no longer actively practice, this collection is my gift to chiropractic with the hope that it will inspire others to seek chiropractic as a possible solution to improve their lives.
 

Letter #1:   Headaches-Asthma-Allergies-Colitis
Letter #2:   High Blood Pressure-Hay Fever-Back Pain
Letter #3:   Skin Rashes-Ear Infections-Asthma-Attention Deficit Hyperactivity Disorder (ADHD)
Letter #4:   Asthma
Letter #5:   Asthma
Letter #6:   Scoliosis-Colds-Pidgeon Toes
Letter #7:   Rashes
Letter #8:   Use of Hand
Letter #8:   Glaucoma
Letter #9:   Skin Rash 
Letter #10:  Walking-Hearing-Seeing
Letter #11:  Rheumatoid Arthritis
Letter #12:  Sinus
Letter #13:  Migraine Headaches
Letter #14:  Back Pain-Spastic Colon-Migraine Headaches
Letter #15:  Headaches - Hip Pain
Letter #16:  Migraine Headaches
Letter #17:  Dizziness - Headaches - Backache
Letter #18:  Dog's Scoliosis
Letter #19:  Leg - Arm - Shoulder - Neck Pain
Letter #20:  Ringing In Ears - Numbness - Stooped Posture
Letter #21:  Hand Tremors - Sinus Problems - Headaches - Neck Stiffness
Letter #22:  Back Pain - Staying Well
Letter #23:  High Blood Pressure
Letter #24:  Headaches - High Blood Pressure
Letter #25:  Rage Issues
Letter #26:  Stroke - Paralysis
Letter #27:  Shoulder Bursitis - Persistent Lower Back Pain
Letter #28:  Neck & Head Burning Pain
Letter #29:  Chronic Rashes and Dermatitis
Letter #30:  Ear Infections-Bronchial Asthma-Bronchitis-Pneumonia-Violet Outbursts

Note: Although these patients responded to care for the above conditions, I only treated their spinal related issues within my scope of practice.  
 

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Work Related Injuries, Recurring Low Back Pain, Chronic Care and Chiropractic Treatment:

A Proven Solution to Save Federal, State and Private Insurers $2,871,485,223

A report on the scientific literature 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Published in Dynamic Chiropractic 8/26/2011 

Low back pain and its treatment are a worldwide epidemic in human suffering and as a result, an economic burden to federal, state, public and self-insured risk takers who insure the injured. In 2009, Russo, Weir and Elixhauser reported that hospital stays for low back pain were 3.9 out of every 1000 people aged 55-64 years. That was rated as the #8 reason for hospital stays and fell closely behind cardiac conditions and degenerative arthritis. While low back pain has been well chronicled, recurring low back pain and the necessity for chronic care is now beginning to realize results that necessitate the proper approach to mitigate its frequency, duration and economic impact as sequella.

A very significant component of low back patient is its recurrence after initial care has been rendered as well as complications that ensue. Wasiak, Kim and Pransky reported in 2006 that, "Recent studies suggest that acute low back pain evolves into a chronic or recurrent condition more often than previously suspected" (p. 220). They went on to report that 40% of individuals with recurring low back pain sought additional care when the pain recurred and 42.9% of those had continued care and work disability lasting more than 201 days, underscoring the significance of the problem.

According to Dagenais, Caro and Haldeman in 2007, "The economic burden of a disease is the sum of all costs associated with that condition which would not otherwise be incurred if that disease did not exist. Given the many categories of costs that must be considered, it can be challenging to fully estimate the economic burden of an illness as data are often unavailable. The term 'cost' in health economics refers to the value of the consequences of using a particular good or service rather than its price...Despite this example, it should be made clear that estimating the economic burden of a disease is not simply a matter of tabulating the amount reimbursed for all clinician services related to a particular diagnosis. The total cost of illness—or economic burden—has three components: (1) direct (medical and nonmedical) costs; (2) indirect costs; and (3) intangible costs" (p. 9). Although indirect and intangible costs are significant burdens, this paper will focus solely on direct costs.

When considering direct costs for work related claims, studies indicate that non-work related indemnity plans should be included for work related low back injuries. Lipscomb, Dement, Silverstein, Cameron, and Glazner reported in 2009 that, "The private health insurance payment rates for workers with one work-related injury were 40% higher than for those with no history of work injury..." (p. 1188). The reasons are simple; indemnity carriers are victims of many workers' compensation carrier tactics created by the indemnity carriers, as reported by Griffin (2007), to deny, delay and defend. Patients need care and will access any system at their disposal so they can get necessary care and return to a normal, pain free lifestyle, leaving the indemnity carriers to absorb those financial costs. Although this is a significant factor, it is difficult to assign numbers and amounts that are directly tied to work related injuries, although those statistics undoubtedly tally in the billions.

Utilizing the Joint Report to the Governor by New York State Workers’ Compensation Board in 2009 as a reference, in 2004 the total number of claims in New York was 143,667 and out of those claims, 19.3% were low back related. The total costs for treating low back was $579,675,476.96, calculated for inflation to 2011 (Tom's Inflation Calculator, 1997-2011, http://www.halfhill.com/inflation.html). This equates to $29.88 per resident to treat work related low back pain. Nationally, this equates to $9,262,855,559 based upon US Census statistics.

Cifuentes, Willets and Wasiak (2011) compared the treatment of recurrent or chronic low back pain. They considered any condition recurrent or chronic if there was a recurrent disability after a 15 day absence and return to disability. Anyone with less than a 15 day absence was excluded from the study.

The study concluded that chiropractic care during the health maintenance care period resulted in:

16% Decrease in disability duration of first episode compared to physical therapy

240% Decrease in disability duration of first episode compared to medical physician's care

6.6% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care

17.2% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care

32% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care

21% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care

The study concluded that chiropractic care during the disability episode resulted in:

24% Decrease in disability duration of first episode compared to physical therapy

250% Decrease in disability duration of first episode compared to medical physician's care

5.9% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care

30.3% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care

19% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care

43% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care

Based upon the Joint Report to the Governor (2009) and the statistics rendered by Cifuentes et al. (2011), the savings with chiropractic care utilized exclusive from medicine and physical therapy ranges from $1,759,942,556 with physical therapy to $3,983,027,890 with medicine. Understanding that most medical physicians utilize physical therapy as a primary tool for back related pain, we will average the savings to $2,871,485,223 by utilizing chiropractic care.

Cifuentes et. al (2011) started by stating, "Given chiropractors are proponents of health maintenance care...patients with work related Low back pain who are treated by chiropractors would have a lower risk of recurrent disability because that specific approach would be used (p. 396). They concluded by stating, " After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type (Cifuentes et. al, 2011, p. 404).

References

1. Russo, A., Wier, L. M., & Elixhauser, A. (2009, September). Hospital utilization among near-elderly adults, ages 55 to 64 years, 2007. Agency for Healthcare Research and Quality, Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp

2. Wasiak, R., Kim, J., & Pransky, G. (2006). Work disability and costs caused by recurrence of low back pain: Longer and more costly than in first episodes. Spine, 31(2), 219-225.

3. Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. Spine, 8(1), 8-20.

4. Lipscomb, H., Dement, J., Silverstein, B., Cameron, W., & Glazner J. (2009). Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003. Journal of Occupational and Environmental Medicine, 51(10), 1185-1192.

5. Griffin, D. (2007, February 7). Insurance companies fight paying billions in claims. Anderson Cooper Blog 360°, Retrieved from http://www.cnn.com/CNN/Programs/anderson.cooper.360/blog/2007/02/ insurance-companies-fight-paying.html

6. New York State Workers’ Compensation Board (2009, March). Joint report to the Governor, From the Superintendant of Insurance and Chair, Workers' Compensation Board, summarizing and benchmarking workers' compensation data and examining progress on prior recommendations for improvement in data collection, Retrieved from http://www.wcb.state.ny.us/content/main/TheBoard/ 2009DataCollectionReport.pdf

7. Halfhill, T. R. (1997-2011). Tom's Inflation Calculator. Retrieved from http://www.halfhill.com/inflation.html

8. U.S. Census Bureau (2010, December 22). U.S. POPClock Projection, Retrieved from http://www.census.gov/population/www/popclockus.html

9. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.

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PRINTED IN THE DYNAMIC CHIROPRACTIC June 17, 2011

Chiropractic Saves Federal and Private Insurers

$15,897,840,000 and Adds $692,160,000

in Wages to Americans

A report on the scientific literature 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

It was reported by Zigler in 2011 that 200,000 spinal fusion surgeries are performed each year, just in the United States alone. An equal number of microdiscectomies are performed as reported by Mayer (2006), which is considered by many to be a conservative number. Let's consider the chiropractic impact of exposing the public to treatment that could avoid needless surgeries, using the 400,000 disc surgeries as a conservative number, not to mention how this could change the unnecessary cost to government and private insurers and lost revenue to both governmental agencies and workers from absenteeism. Allen and Garfin (2010) reported that spine-related health care expenditures totalled over $97.5 billion (2011 inflation adjusted), a 65% increase from 1997. With an aging population, this trend, based on the biomechanics of the aged, will continue.

It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.

The study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates. Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.

Let's do the math. If we take the 400,000 disc surgeries (adding cervical surgeries to the equation) done each year as discussed in the opening paragraph and apply McMorland et al.'s (2010) findings that 60% of surgical candidates had successful outcomes with chiropractic as an alternative to surgery, 240,000 patients yearly could avoid needless surgery if they sought chiropractic care.

According to Sherman, Cauthen, Schoenberg, Burns, Reaven and Griffith in 2010, the 2010 inflation adjusted amount per case in Medicare dollars is $13,243.82 per patient once you take into consideration the complications, but exclude many other variables such as repeated MRI's, myelograms, and many hospital charges. Allen and Garfin (2010), taking into account total charges, including mean hospital charges for a single level, uncomplicated, minimally invasive surgery, reported the cost to be $70,159 for all payors. They also went on to report that for 2-level disc surgeries the complication rate increased by 25% with significantly more costs.

If you consider 240,000 preventable surgeries at $70,159 per patient, that equates to $16,838,160,000 healthcare dollars that did not have to be spent. MEDSTAT, as reported by Chiropractic Lifecare of America (2009), estimated that the average cost of chiropractic care per patient per case is $3,918 (2011 inflation adjusted dollars.) If you take this amount and apply it to the 240,000 unnecessary surgeries, you have a net savings of $66,241 per patient. The net savings to the Medicare system and private insurers is $15,897,840,000.

According to Fayssoux, Goldfarb, Vaccaro, James (2010) who studied the indirect costs associated with surgery for low back pain, the average lost productivity related to absenteeism resulted in lost wages of $2,884 per patient for the first postoperative year. "The findings demonstrate the significant, though not surprising, impact of spinal disability on productivity, and the importance of including measurement of lost productivity and return to work..." (Fayssoux et al., 2010, p. 9). This equals an additional $692,160,000 in wages to Americans per year by taking the necessity of absenteeism out of the equation with no surgeries to recover from.

Chiropractic offers solutions to the federal government, local government, and public and private insurance companies by avoiding unnecessary surgeries. Chiropractic offers solutions to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.

References:

1. Zigler, J. (2002). Lumbar artificial disc surgery for chronic back pain. spine-health. Retrieved fromhttp://www.spine-health.com/treatment/artificial-disc-replacement/lumbar-artificial-disc-surgery-chronic-back-pain

2. Allen, R. T., & Garfin, S. R. (2010). The economics of minimally invasive spine surgery: The value perspective. Spine, 35(Suppl. 26), 375-382.

3. Mayer, H. M. (Ed.). (2006). Minimally invasive spine surgery: A surgical manual. Germany: Springer.

3. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.

4. Sherman, J., Cauthen, J., Schoenberg, D., Burns, M., Reaven, N. L., & Griffith, S. L. (2010). Economic impact of improving outcomes of lumbar discectomy. The Spine Journal, 10(2), 108–116.

5. Chiropractic Lifecare of America. (2009). The MESTAT Project. Learning. Retrieved from http://www.clahealthcare.com/learning/index.html

6. Fayssoux, R., Goldfarb, N. I., Vaccaro, A. R., & Harrop, J. (2010). Indirect costs associated with surgery for low back pain—A secondary analysis of clinical trial data. Population Health Management, 13(1), 9-13.

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