Managed Care Preapproval and its Effect
on the Cost of Utah Worker Compensation Claims

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

FROM:   J Manipulative Physiol Ther 1997 (Jul); 20 (6): 372–376

K B Jarvis, R B Phillips, C Danielson

Los Angeles College of Chiropractic,
Whittier, CA 90609-1166, USA.

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Objective:   To determine the effect of preauthorization of chiropractic services costs in non-surgical back injury cases in a managed care environment. The program was implemented in the chiropractic provider group by the Worker Compensation Fund of Utah. The results were compared with those of similar injury claims in a separate provider group in which there was no preauthorization program.

Design:   The study was a retrospective review of approximately 5000 claims from 1986 and 5000 claims from 1989 of injured workers in the Utah Worker Compensation Fund. We extracted approximately 1000 nonsurgical back-related injury claims from each year.

Main outcome measure:   Cost comparisons between medical and chiropractic provider groups in the management of nonsurgical compensable back pain in both 1986 and 1989.

Results:   Treatment costs in cases managed by chiropractic physicians increased 12% between 1986 and 1989. Treatment cost in cases managed by medical physicians increased 71% in the same time period. Compensation (wage replacement) costs increased 21% for the chiropractic group and 114% for the medical group.

Conclusion:   Retrospective analysis of worker compensation databases continue to struggle with issues related to measurement of severity, appropriate condition identification, adequate inclusion of all related costs and unbiased case selection. Treatment costs appeared to be controlled under the auspices of a preapproval program required of the chiropractic physician whereas medical costs escalated in the absence of price controls.

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