Chiropractic Treatment of Workers'
Compensation Claimants in the State of Texas

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   MGT of America, Austin, Texas ~ February 2003

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This retrospective study of workers’ compensation claims from 1996 to 2001 was conducted to determine the use and efficacy of chiropractic care in Texas. The researchers reviewed 900,000 claims during that time period to determine if chiropractic was cost-effective compared to medical treatment. They found that chiropractic treatment costs were the lowest of all providers. The study data demonstrated that increased utilization of chiropractic care could lead to declining costs relative to lower back injuries.

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In 2002, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to workers' compensation, the results of which were published in February 2003. According to the report, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low-back injuries. They found: Lower back and neck injuries accounted for 38 percent of all claims costs. Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs.

These findings were even more intertesting: The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202. If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent, to $7,632.

Doctors of chiropractic have been licensed to practice in Texas since 1949 and have been a fundamental part of the state's workers' compensation system since 1953. Each year, Texas DCs treat tens of thousands of injured workers, but until recently, little data were available comparing the cost-effectiveness and efficacy of chiropractic versus other forms of care available through the workers' compensation program.

Last year, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to workers' compensation, the results of which were published in February. According to the report, Chiropractic Treatment of Workers' Compensation Claimants in the State of Texas, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low-back injuries, and is not a contributor to the state's rising worker's compensation costs.

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The study considered two questions:

1. Does chiropractic play a significant role in driving the escalating costs
   in the Texas workers' compensation system?
   

2. Is chiropractic a cost-effective treatment option within the state's
   workers' compensation system?

To answer these questions, the national research/consulting firm MGT of America was hired to review more than 70 articles and published studies on the cost and effectiveness of chiropractic care. The firm also analyzed data on approximately 900,000 workers' compensation claims filed from 1996 to 2001.

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Among the firm's findings:

• Of the nearly 900,000 workers' compensation claims received from 1996 to 2001, only 14.6 percent of claimants were treated by doctors of chiropractic, and only 8.5 percent of those workers received more than half of their treatment from chiropractors.
  

• Chiropractic care accounted for only 12.5 percent of medical fees and 6.9 percent of the total workers' compensation costs. However, the firm noted that these figures did not include the costs of pharmaceuticals, because insurers are not required to provide such information to the Texas Workers' Compensation Commission (TWCC). If those costs were included, the percentage of costs related to chiropractic care would have been even lower.
  

• Lower back and neck injuries accounted for 38 percent of all claims costs. Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs.
  

• The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202. If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent, to $7,632.

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Based on its analysis, the firm reached two noteworthy conclusions:

1. Chiropractic's medical costs are the lowest in the state's workers' compensation system.   "The existing body of research indicates that chiropractic is a cost-effective means of treatment for musculoskeletal injuries," the firm noted. "Chiropractic care is associated with lower medical costs and more rapid recovery in the overwhelming majority of studies concerning chiropractic care and workers' compensation costs." Data from the study also clearly linked increased use of chiropractic care with lower costs relative to lower back injuries.
   

2. Chiropractic cannot be blamed for the state's rising workers' compensation costs.   Based on the evidence, the firm found it "unlikely" that chiropractic could be held responsible for escalating costs: "Our analysis of TWCC claims data demonstrated that chiropractic currently plays a relatively small role in the system as a whole, and therefore could not be a significant force in driving costs ... to be a significant factor in driving costs, chiropractic would have to be demonstrated as a vastly more expensive means of treatment, or it would have to comprise a greater share of treatment in this system."

To get a better grasp of the effectiveness of all forms of care, MGT also recommended that TWCC require insurers to provide all information requested on its workers' compensation forms - particularly pharmaceutical costs and return-to-work data.   Including this information would provide a more complete picture of how patients are treated under the workers' compensation system, and result in “further decreases in the overall cost to the system.”

The complete TCA/MGT study can be purchased from the TCA at:

Texas Chiropractic Association,
815 Brazos, Suite 802,
Austin, TX 78701
For more information, call (512) 477-9292.

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Since 5-25-2003