Proposed cut a setback for Mass. chiropractors?
In the last 30 years, chiropractors have been able to shed much of the skepticism that surrounded their discipline and enter the mainstream health care industry as providers who treat myriad conditions that cause chronic pain.
But some of that skepticism lingers, relegating chiropractic services to the “add on” category, meaning they’re viewed as helpful but not vital health care services, according to Michael Finnegan, owner and chiropractor at Chiropractic Associates of Worcester.
“We’re the black sheep of the family, to some extent,” Finnegan said.
Gov. Charlie Baker’s proposal to cut chiropractic services for the state’s 1.7 million projected MassHealth patients in his fiscal 2016 state budget is symptomatic of that sentiment, according to Finnegan. He said when money is tight – as it usually is, for MassHealth—health care providers in fields that are viewed as ancillary, such as mental health, podiatry and dentistry, as well as chiropractic services, are often first on the chopping block.
Proposal maintains most benefits, but cuts $300K for chiropractic care
This year, chiropractic services are the lone item on the block, though. Baker’s proposed MassHealth budget avoids cutting other benefits and doesn’t change eligibility standards for enrollees. But unless the legislature moves to maintain funding, the $300,000 line item for chiropractic services will be eliminated in fiscal 2016, which begins July 1.
Finnegan, who has more than 20 years of experience, said funding levels for chiropractic services have ebbed and flowed since MassHealth first started covering chiropractic services 15 years ago. He said the field is an easy target because chiropractors represent a relatively small proportion of providers in the Bay State.
Baker’s proposal will not have a significant impact on Finnegan’s practice, since he doesn’t currently see patients who receive MassHealth, but he predicted that those who do will view the cut as a hardship. But Finnegan said it’s the patients who stand to lose the most if chiropractic services are cut. That’s because they’re less likely to be able to afford to pay for services out-of-pocket. Finnegan said exams tend to range from $100 to $200 per visit while weekly treatments are about $30—cheap compared to visits with other types of providers, but still cost-prohibitive for many who receive MassHealth benefits.
And there’s evidence that chiropractic services actually reduce health care costs by preventing surgeries and the need for prescription painkillers. A 2009 report by Mercer found that chiropractic treatment of low-back pain compared “extremely favorably” in cost effectiveness for health insurance plans compared to the most widely used medical treatments.
This is why commercial insurers provide wide coverage for chiropractic services, according to Steven Saro, president of the Massachusetts Chiropractor Society. Saro said reimbursement has improved dramatically in the last 20 years because of how effective chiropractic treatment is at treating pain and reducing the need for more expensive medical interventions.
The 'wrong direction' for health care?
As more agencies and private insurers began offering coverage, chiropractors began to feel validated, according to Saro. The first step toward legitimizing the field came when Medicare began providing chiropractic services for senior citizens in the 1970s, Saro said. Before that time, chiropractors were frequently viewed as non-traditional medical practitioners, an attitude that has mostly been eradicated today.
“Reimbursement has gotten better because there’s greater demand for our services,” Saro said.
But in cutting services for MassHealth patients, Saro said Baker is taking the “wrong direction” at a time when the health care industry is focusing on preventative treatment as a means to lower health care spending while improving quality, and the industry will respond to his proposal by providing him with data that shows how chiropractic care drives down costs.
Baker was not available for comment, but spokeswoman Elizabeth Guyton, noted in an e-mail statement that Baker inherited a $1.8 billion state budget deficit, which he is fixing “through careful consideration,” and “without raising taxes or fees while investing in education and transportation to foster economic growth.”
Michael Nickey, executive director of the MassHealth program at Worcester-based insurer Fallon Health, recognized that chiropractic services are viewed by many as preventative medicine. But he said other benefit areas are probably more crucial to MassHealth patients; he noted that chiropractic services generally aren’t used at high levels by the MassHealth patients to whom Fallon administers benefits.
Image source: Freedigitalphotos.net
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