Helping to mend back strains and sprains for workers costs 30 percent more to achieve similar outcomes when directed by a chiropractor instead of a physician, according to a study by the Workers Compensation Research Institute. The reason is the higher number of visits to chiropractors per case.

The study, "Patterns and Costs of Physical Medicine: Comparison of Chiropractic and Physician-Directed Care," analyzes 28,539 workers' compensation cases involving back problems in California, Connecticut, Florida, Massachusetts, and Texas.

It says that the average payment per workers' compensation claim was 30 percent higher in chiropractic-treated cases in Texas, California, and Connecticut to achieve the same duration of disability as in physician-directed care. That's because chiropractic-treated claims involve more than double the number of visits, although the payment per visit is 19 percent to 24 percent lower.

"On average, chiropractors use 137 [percent to] 158 percent more visits that provide physical medicine services and 74 [percent to] 90 percent more visits for which office visits are billed than when physical medicine care is physician-directed," say the authors.

Physical medicine services include manipulations and adjustments, supervised exercise, hot and cold packs, electrostimulation, and massage. They account for about 20 percent of total medical costs in workers' compensation cases and are most often used for back injuries.

"Learning more about how these services are delivered and how their costs differ can help improve outcomes to injured workers and also lower overall system costs," says Richard Victor, PhD, JD, one of the authors of the study.

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