Medicare's Demonstration of Expanded Coverage for Chiropractic Services: Limitations of the Demonstration and an Alternative Direct Cost Estimate

作者：William Brinson Weeks, James M. Whedon, Andrew Toler, Christine Goertz · 发表于：Journal of Manipulative and Physiological Therapeutics · 年份：2013 · DOI：10.1016/j.jmpt.2013.07.003 · 被引用次数：11 · 研究领域：Musculoskeletal pain and rehabilitation、Healthcare Policy and Management、Primary Care and Health Outcomes

OBJECTIVE: The purposes of this study were to examine the direct costs associated with Medicare's 2005-2007 "Demonstration of Expanded Coverage of Chiropractic Services" (Demonstration) and their drivers, to explore practice pattern variation during the Demonstration, and to describe scenarios of cost implications had provider behavior and benefit coverage been different. METHODS: Using Medicare Part B data from April 1, 2005, and March 31, 2007, and 2004 Rural Urban Continuum Codes, we conducted a retrospective analysis of traditionally reimbursed and expanded chiropractic services provided to patients aged 65 to 99 years who had a neuromusculoskeletal condition. We compared chiropractic care costs, supply, and utilization patterns for the 2-year periods before, during, and after the Demonstration for 5 Chicago area counties that participated in the Demonstration to those for 6 other county aggregations-urban or rural counties that participated in the Demonstration; were designated comparison counties during the Demonstration; or were neither participating nor comparison counties during the Demonstration. RESULTS: When compared with other groups, doctors of chiropractic in 1 region (Chicago area counties) billed more aggressively for expanded services and were reimbursed significantly more for traditionally reimbursed chiropractic services provided before, during, and after the Demonstration. Costs would have been substantially lower had doctors of chiropractic in this 1 reg...