The cost impact of a quality-assured mechanical assessment in primary low back pain care

ABSTRACT

Objectives: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC).

Study Design: Administrative claims data analysis.

Methods: Employees and dependents of a large self-insured manufacturer seeking care for LBP in 2013 chose between the company’s primary care clinic (where MC was delivered) and community care.

The claims of 5,036 were analyzed for one year following subjects’ initial evaluation excluding only those with diagnostic codes for fractures, dislocations, or infections. MC included an advanced form of Mechanical Diagnosis & Therapy (MDT). CC varied based on each subjects’ selection of providers. Primary outcome measure: one-year cost of each subject’s care. Secondary: number of MRIs, spinal injections, and lumbar surgeries undertaken. The payer’s proprietary risk-adjustment algorithm was utilized.

Results: After risk adjustment, the average cost per MC subject was 51.48% lower than the CC average cost (p < .0279). The utilization of MRIs, injections, and surgeries was lower with MC by 49.75%, 39.44%, 78.38% with relative risks of 1.99, 1.64, and 4.73, respectively.

Conclusions: This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with MC, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention.

Level of Evidence: 1b.

KEYWORDS:

• Low back pain
• cost-savings
• Mechanical Diagnosis & Therapy
• risk-adjustment
• observational longitudinal cohort
• quality-assured

Additional information

Funding

Partially funded by The International Mechanical Diagnosis & Therapy Foundation, No. M022013.

Notes on contributors

Ronald Donelson

Ronald Donelson, is a board-certified orthopedic surgeon who specialized in and researched non-operative spine care for 30 years. He earned his Diploma in Mechanical Diagnosis & Therapy in 1990 and a Master of Science degree from The Dartmouth Institute in 1999. He founded and is the President of SelfCare First, LLC whose mission is to globally improve the quality and cost of care for individuals seeking help for painful low back, neck, and all other musculoskeletal disorders. He has published many research studies, chapters, review articles and presented over one hundred research papers, conference workshops, courses, and symposia in more than 15 countries.  He published two books about precisely diagnosing and treating individuals with low back pain. Donelson has no consulting, equity, or advisory role with Integrated Musculoskeletal Care (IMC) and received no funding from either IMC or the International Mechanical Diagnosis & Therapy Research Foundation (IMDTRF) for leading this project.

Kevin Spratt

Kevin Spratt, earned his Ph.D. at the University of Iowa (UI) as a methodologist, a statistician and psychometrician. At the UI College of Education and the Department of Orthopedics, he focused on reliability and validity research in school achievement testing and patient self-reported health states. He has published over 100 research articles, won prestigious awards including the Kappa Delta Award, 3 Volvo Awards, and two North American Spine Society best paper awards; authored six book chapters, been a deputy editor for Spine for more than 30 years and regularly reviews articles in the European Spine and the Spine Journals. Retired in 2017, he continues to mentor medical students and residents understanding research methods and being critical evaluators of clinical research.Spratt has no financial and/or business interests related to this study.  He was funded by the IMDTRF as statistician, experimental design, data cleaning, analysis, and interpretation.  He signed a confidentiality agreement with the Fortune 500 company prohibiting the sharing of this study’s data without their permission.

W. Steve McClellan

W. Steve McClellan earned his MS in Quantitative Analysis in the College of Social Science at Florida State University. He then developed and analyzed products and services for national markets as well as financial analysis and management at Florida State. He joined Integrated Musculoskeletal Care (IMC) in 2015 to help define and launch their product and service offerings utilizing predictive analytics for musculoskeletal health. McClellen was an employee of IMC during this project.

Richard Gray

Richard Gray graduated from Florida A&M University in 1994, earned a Mechanical Diagnosis and Therapy credential from the McKenzie Institute International in 2002, served on the Board of McKenzie Institute U.S.A., taught Accountable Community Development, and has been a clinical practitioner for two decades.  He is presently the CEO of Integrated Musculoskeletal Care focused on innovations in musculoskeletal diagnostics, health care and self-care. He is a thought and practice leader in group health, workers’ compensation, and disability outcomes optimization. He is a regular speaker at national orthopedic conferences and a guest lecturer in a broad range of clinical education settings. Gray is the Chief Executive Officer of IMC.

J. Mark Miller

J. Mark Miller graduated from the University of Toronto in 1987 and co-developed the McKenzie Institute International’s North American clinical residency program. He has been a clinical practitioner for 27 years and is a widely recognized health industry. He is Co-Founder and currently serves as Vice President of Clinical Operations for Integrated Musculoskeletal Care (IMC) with a focus on optimizing musculoskeletal outcomes.  He has served on the faculty of the McKenzie Institute International and U.S.A. for over 20 years teaching over 270 continuing education courses in Mechanical Diagnosis and Therapy (MDT) to physicians, chiropractors, physical therapists and others worldwide. Miller is the Vice President of Clinical Operations for IMC.

Eric Gatmaitan

Eric Gatmaitan earned a bachelor of science degree in industrial engineering with a minor in mechanical engineering from De La Salle University followed by an MBA in business information systems from Western Michigan University. He authored four books: Manager's Guide to Lean and Performance, Lean and Performance Driven, Building a Citadel, and Beginner's Guide to Crystal Reports and was a faculty member at Western Michigan University teaching computer technology application and programming. In industry, he served as an industrial engineer, production supervisor, plant manager, and chief operating officer. Now working for an industrial engineering and consulting firm, he leads projects and conducts training in business process optimization, quality management systems, and performance management systems. He was a data consultant with lntegrated Musculoskeletal Care.