Wednesday, July 13, 2005

Medicare Overpaid for Chiropractic

The Washington Post reported that the Inspector General of the US Department of Health and Human Services concluded that Medicare overpaid chiropractors about $285 million in 2001, about two-thirds of the total paid that year for chiropractic services. Most of the excess payments went for "maintenance treatments," periodic manipulation of the spine in absence of specific symptoms, which Medicare currently considers ineffective. The American Chiropractic Association claimed, however, that the issue was really "a universal problem in physician documentation."
This apparently will not discourage the Center for Medicare and Medicaid Services (CMS) from starting a pilot program to increase coverage of chiropractic care. According to the Mark McClellan, CMS administrator, the program is meant "to evaluate whether expanding coverage of chiropractic services reduces overall Medicare expenditures for neuromusculoskeletal conditions." The article did not mention whether it was also meant to improve patients' health outcomes.
Of course, I haven't heard about any CMS pilot programs to pay more for physicians' services for primary care, yet, as we have documented, their reimbursement has failed to keep up with rising overhead expenses.
Again, this is a reminder that most cost-cutting efforts by federal payers and managed care organizations seem to have been directed to across-the-board cuts of reimbursement for general primary care and acute care services, while the prices of some "complementary and alternative medicine" (like chiropractic), on one hand, and some "high technology," like BilDil and Thalidomid, go unchallenged.

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