Articles by JCS
August 14, 2014
Mayor Randy Toms
Warner Robins, GA
RE: How to Cut Insurance Costs
I read with disbelief in today’s Telegraph the article, “Warner Robins looks to cut insurance costs,” by Mike Stucka about the huge cost of $1.35 million for 44 incidents of “muscle strains,” which equates to $30,681 per incident.
Either this amount is a typographical error or clearly a situation of the outrageous medical costs and “perverse motivation” that are embedded in the workers compensation (WC) insurance industry.
I am compelled to respond to this situation as a taxpayer and a 35-year chiropractic practitioner in Warner Robins who deals with muscle strains and spine-related disorders daily since this amount is shocking but typical of the high cost of medical spine care and hospitalization.
Considering the top 10% of orthopedists average $743,257 according to Becker’s Spine Review, it’s easier to understand these huge costs for simple “muscle strains.”
Let me speak from experience. I first learned of this “perverse” situation in 2000 while attending a WC Summit conference initiated by then-governor Roy Barnes to “lower costs and improve outcomes.” I represented the Georgia Chiropractic Association at that event where I was introduced to this scam in WC that continues to this day.
At the WC Summit I learned of the typical ruse from a WC attorney who told me, “the more WC companies pay in medical costs, the more they can charge in premiums, then there’s more money for them to invest for themselves, so there’s more money for everyone.” Such a deal, eh?
The fact is the WC carriers simply don’t care about the most clinical and cost-effective care for patients; if they did, they would follow the guidelines that recommend conservative chiropractic care first.
However, working from this perverse motivation, the WC insurance companies have a clear bias against the ‘cheapest mousetrap’, if you will, namely chiropractic care.
I once spoke with a WC executive who admitted his company did not refer to chiropractors (although we are included in WC laws as providers) because “you’re too cheap.” In this era of healthcare reform, this attitude illustrates why America’s healthcare is in dire straits.
Of course, these high costs are passed on to those paying the premiums—the employers or taxpayers in this case. The patients who are mistreated pay dearly, too, in terms of lost wages and disability.
After the conference, I wrote “A Chiropractic Proposal for the Governor’s Advisory Council on Workers’ Compensation” to suggest ways to reduce costs and improve outcomes in the area of spine-related disorders that constitute the #1 ailment in workers comp. I hope you can find the time to read this proposal to become aware of the research and guidelines of this skewed and costly situation that would save the state and your city a lot of money.
Simply put, today’s evidence-based guidelines do not recommend narcotic painkillers, epidural steroid injections, and spine surgery for the vast majority (90%) of spine-related disorders, including “muscle strain.” The 10% of cases that require medical spine care constitute fractures, cancers, serious infections like staph or TB, or cauda equina syndrome, but these are not the typical on-the-job type injuries.
Even if the WR City Council’s Insurance Committee shops around to find more carriers as the article mentions, the real cost will not be reduced since they all have the same perverse motivation. According to the newspaper article, a WC insurance broker suggested "the city should consider some things, such as deductibles and out-of-pocket costs, to save money." I daresay transferring costs to patients is pale in comparison to finding a WC insurance company without a perverse motivation, if that's possible.
Simply changing to another WC insurance carrier with the same medical (drugs, shots, surgery) approach will be equivalent to a statement attributed to Albert Einstein: “Insanity is doing the same thing over and over again and expecting different results.”
The best answer to improving outcomes and reducing costs for these muscle strain and back cases is to refer them initially to chiropractors instead of MDs or PTs as the guidelines now suggest.
However, the WC insurance companies have a virtual boycott of chiropractors. Too often patients are told WC does not cover chiropractors, which is untrue, or they are forced to see an MD gatekeeper first who rarely, if ever, refers to a chiropractor since the turf war still exists in the medical war against chiropractors.
For example, RAFB has had the same problem for years despite the fact that George Bush signed into law a bill calling for chiropractors in TRICARE. I filed a FOIA inquiry for the year 2012 concerning the number of back related injuries and discovered of the 2512 spine-related injuries, none were referred to chiropractors. As you may recall, when BRAC last investigated RAFB in 2005, the high WC costs was the biggest black spot on its record. To this day, RAFB is still in jeopardy when time comes for another visit by BRAC.
This obstruction flies in the face of numerous cost-comparative research studies and ‘best practices’ guidelines that show chiropractic care is faster, cheaper, safer, and returns injured workers quicker than medical spine care. It also explains why there presently is a Hillbilly Heroin epidemic in the VA program where opioids are handed out like Halloween candy.
It also flies in the face of “INFORMED CONSENT” law that requires all doctors to tell patients of their choices of treatments, all options, risks, costs, etc. As we know, too many injured patients are forced to take narcotic painkillers, epidural steroid injections, or to have disc fusions that are unnecessary and are rarely, if ever, told chiropractic care for low back pain is a “proven treatment.”
The bottom line is: If you want to cut insurance costs, use chiropractors first.
As a concerned citizen and health practitioner, I volunteer to be a part of the risk-assessment committee. If you sincerely want to understand this problem, the new research supporting chiropractic care, and the new spine care guidelines, I would be happy to give you a copy of my new book just as I gave a copy to former Mayor Shaheen and Mayor John Harley.
JC Smith, MA, DC
Smith Spinal Care