Table 3.
Un-weighted and propensity score weighted spending and outcomes results (with standard errors in parentheses) for the entire episode of care (top) and per episode day (bottom) for older Medicare Part A and Part B enrollees in 2007–2012 with chronic low back pain episodes multiple comorbidities across 4 treatment groups. DC means doctor of chiropractic; PT means physical therapy; DO means doctor of osteopathy; CMT means chiropractic manipulative treatment; and SMT means spinal manipulation therapy.
| N | Mean days in an episode |
Medicare expenditures during the episode ($) | 1 year post-episode events |
||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total Part A and Part B |
Part A | Part B | Part D* | Back surgery (%) |
Future claims for back pain treatment (%) |
||||||||||
| Total | On CMT |
On Psychiatric care |
On PT care |
For DO SMT |
Total | On pain meds |
|||||||||
| Expenditures during the entire episode | Un-weighted | Only used CMT | 3,909 | 298 (4.9) |
3,010 (144) |
1,168 (94) |
1,842 (50) |
478.51 (4.01) |
19.82 (2.70) |
6.82 (1.24) |
0.04 (0.07) |
1,905 (164) |
300.47 (37.59) |
0.10 (0.051) |
31.8 (0.75) |
| Used conventional medical care first, then CMT |
3,563 | 367 (5.6) |
8,277 (251) |
4,070 (185) |
4,207 (80) |
329.93 (3.49) |
32.71 (3.64) |
71.47 (4.19) |
2.73 (0.61) |
3,054 (209) |
497.95 (48.79) |
1.21 (0.183) |
31.3 (0.78) |
||
| Used CMT first, then conventional medical care |
5,235 | 481 (5.3) |
8,993 (216) |
4,843 (166) |
4,150 (65) |
332.17 (2.89) |
35.29 (3.12) |
41.95 (2.65) |
1.52 (0.38) |
3,802 (200) |
532.66 (43.28) |
0.86 (0.128) |
20.0 (0.55) |
||
| Did not use CMT | 59,619 | 455 (1.5) |
11,231 (71) |
6,730 (58) |
4,501 (20) |
0.00 (0.00) |
51.32 (1.11) |
34.08 (0.71) |
1.49 (0.11) |
4,882 (64) |
747.54 (14.44) |
0.54 (0.030) |
12.6 (0.14) |
||
|
Propensity score weighted |
Only used CMT | 3,909 | 287 (2.1) |
3,581 (66) |
1,429 (45) |
2,152 (25) |
522.24 (3.97) |
31.85 (1.67) |
6.62 (0.57) |
0.03 (0.02) |
2,381 (75) |
355.25 (15.74) |
0.04 (0.008) |
31.9 (0.17) |
|
| Used conventional medical care first, then CMT |
3,563 | 369 (2.4) |
8,721 (105) |
4,351 (80) |
4,370 (37) |
323.68 (3.18) |
37.52 (1.85) |
72.22 (1.91) |
2.67 (0.23) |
3,751 (95) |
537.19 (19.58) |
0.81 (0.034) |
30.3 (0.17) |
||
| Used CMT first, then conventional medical care |
5,235 | 486 (2.8) |
10,271 (113) |
5,567 (90) |
4,704 (38) |
342.72 (3.25) |
44.28 (1.99) |
43.14 (1.47) |
1.58 (0.18) |
4,387 (106) |
576.08 (21.01) |
0.65 (0.030) |
17.0 (0.14) |
||
| Did not use CMT | 59,619 | 454 (2.7) |
11,039 (117) |
6,593 (98) |
4,446 (37) |
0.00 (0.00) |
49.06 (2.09) |
35.88 (1.34) |
1.61 (0.18) |
4,744 (112) |
734.27 (24.09) |
0.62 (0.029) |
13.1 (0.13) |
||
| Expenditures per episode day | Un-weighted | Only used CMT | 10.10 (0.50) |
3.92 (0.34) |
6.18 (0.15) |
1.61 (0.01) |
0.07 (0.009) |
.02287 (.00486) |
.00014 (.00029) |
6.30 (0.37) |
0.99 (0.10) |
||||
| Used conventional medical care first, then CMT |
22.57 (0.70) |
11.10 (0.53) |
11.47 (0.20) |
0.90 (0.01) |
0.09 (0.010) |
.19480 (.01338) |
.00745 (.00198) |
8.50 (0.40) |
1.39 (0.11) |
||||||
| Used CMT first, then conventional medical care |
18.69 (0.46) |
10.06 (0.37) |
8.63 (0.12) |
0.69 (0.01) |
0.07 (0.006) |
.08718 (.00645) |
.00317 (.00093) |
7.98 (0.29) |
1.12 (0.07) |
||||||
| Did not use CMT | 24.69 (0.16) |
14.80 (0.14) |
9.90 (0.04) |
0.00 (0.00) |
0.11 (0.002) |
.07492 (.00182) |
.00328 (.00029) |
10.67 (0.10) |
1.63 (0.02) |
||||||
| Propensity score weighted | Only used CMT | 12.50 (0.22) |
4.99 (0.16) |
7.51 (0.07) |
1.82 (0.01) |
0.11 (0.005) |
.02311 (.00210) |
.00010 (.00010) |
8.57 (0.18) |
1.28 (0.04) |
|||||
| Used conventional medical care first, then CMT |
23.64 (0.28) |
11.79 (0.22) |
11.84 (0.08) |
0.88 (0.01) |
0.10 (0.004) |
.19570 (.00547) |
.00722 (.00080) |
10.15 (0.17) |
1.45 (0.04) |
||||||
| Used CMT first, then conventional medical care |
21.13 (0.23) |
11.45 (0.19) |
9.68 (0.06) |
0.71 (0.01) |
0.09 (0.003) |
.08874 (.00318) |
.00325 (.00046) |
9.12 (0.14) |
1.20 (0.03) |
||||||
| Did not use CMT | 24.32 (0.25) |
14.52 (0.22) |
9.79 (0.07) |
0.00 (0.00) |
0.11 (0.004) |
.07905 (.00311) |
.00355 (.00050) |
10.39 (0.16) |
1.61 (0.04) |
||||||
*
Part D expenditures are calculated from only those patients who were enrolled in Medicare Part D