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Chiropractic Before Spine Surgery
for Chronic LBP
University of
Pittsburgh Medical Center Health Plan mandates conservative care before
considering surgery for chronic LBP cases.
By Peter W. Crownfield, Executive Editor
The University of Pittsburgh Medical Center (UPMC) Health Plan,
a health maintenance organization affiliated with the university's School of
Medicine, has adopted landmark guidelines for the management of chronic low back pain. As of Jan. 1,
2012, candidates for spine surgery must receive "prior authorization to
determine medical necessity," which includes verification that the
patient has "tried and failed a 3-month course of conservative
management that included physical therapy, chiropractic therapy, and
medication." Surgery candidates also must be graduates of the plan's LBP
health coaching program. The program features a Web-based decision-making
tool designed to help plan members "understand the pros and cons of
surgery and high-tech radiology." It is the first reported
implementation of such a policy by a health care plan.
Putting a Clamp on the Soaring Rates of Spine Surgery
According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and
the rationale for their implementation, "We feel strongly that this
clinical initiative will improve the quality of care for members who are
considering low back surgery, and that it will facilitate their involvement
in the decision-making process." The update also noted, "Surgical
procedures for low back surgery performed without prior authorization will
not be reimbursed at either the specialist or the
hospital level."
Commenting on the UPMC Health Plan guidelines, Gerard Clum, DC,
former president of the World Federation of Chiropractic and Life
Chiropractic College West, and current executive committee member of the
Foundation for Chiropractic Progress, stated:
"The UPMC should be congratulated for its leadership is
establishing policies to assure that the least invasive and most likely to be
successful care strategies, including chiropractic care, are applied for a
meaningful period of time before surgical considerations are made. This
decision is both an important recognition of the value of chiropractic care
in the acute low back pain environment as well as a recognition of the
clinical and economic downsides to spinal surgery in this situation."
Headquartered in Pittsburgh, the UPMC Health Plan covers insured in 15 counties in western Pennsylvania. The plan
integrates 20 hospitals, 400 doctors' offices and outpatient sites.
Chiropractic Services: What the UPMC Health Plan Covers
"It is the policy of UPMC Health Plan to recognize
chiropractic services and adjunctive procedures as appropriate and consistent
with good medical practice and will provide coverage when the services are
medically necessary and covered by the member's benefit plan for the specific
indications detailed in this policy. Coverage is limited to medically
necessary services provided by a licensed doctor of chiropractic, within the
scope of his/her license."
"Covered chiropractic services include evaluation and
management, manipulation, spinal X-rays, therapeutic exercise, and adjunctive
procedures that are appropriate and medically necessary for
neuromusculoskeletal conditions. ... Indications for Chiropractic Services:
Indicated for primary, neuro-musculoskeletal symptoms involving the spine,
para-spinal soft tissues, and extremities. Indications for
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A Conservative
Strategy for Managing Chronic LBP
• PCP discussion related to self-care consisting of rest, ice, compression and elevation (RICE) • Screening for psychosocial factors or "yellow flags" and incorporate behavioral interventions as appropriate with other treatment interventions • Education on self-management techniques – functional ability assessment and education on return to work / usual activity and function • Enrollment and graduation from UPMC Health Plan Health Coach's Low Back Pain Program (mandatory) which may also include participation in other programs such as weight loss, physical activity, tobacco cessation, depression and/or stress • Early referral to chiropractor or physical therapist, but before advanced imaging, for manipulation/mobilization; stabilization exercises; directional preference strategies – member and/or provider movements that abolish or cause centralization of pain (McKenzie self-treatment repeated movements that centralize pain) • Detailed documentation of extent and response to conservative treatment including chiropractor/physical therapy documentation SOURCE: UPMC Health Plan Policy and Procedure Manual, October 2011: Surgical Management of Low Back Pain (partial list of considerations prior to spine surgery to determine medical necessity). Complete policy available atwww.upmchealthplan.com/pdf/PandP/MP.043.pdf. |
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| Dr. Stephen Kelly and Dr. Joelle Johnson of Family First Chiropractic and Wellness |
Manipulation: Manipulation is appropriate to restore function that
has been reduced or lost by illness or injury. Indications for Adjunctive
Procedures: Adjunctive procedures are appropriate to restore function and
prevent disability following injury. Indications for Therapeutic Exercise:
Indicated for improvement or to restore functional status by building strength,
endurance and flexibility of the affected region."
Dr. Stephen Kellya nd Dr. Joelle Johnson practice at Family First Chiropractic and Wellness, 142 Erickson drive, Red Deer. T4R 2C3 403-347-3261 www.family1stchiro.ca
