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Attorney General George Jepsen announced today that Aetna and American Specialty Health Networks, Inc. have agreed to review and reprocess chiropractic benefit claims that may have been denied improperly under Connecticut law.
The company was responding to questions raised by the Attorney General after several complaints were made by chiropractic providers on behalf of themselves and their patients. They were concerned that Aetna’s claims administration agreement with American Specialty Health Network, which took effect July 1, did not appear to include all the chiropractic services covered under Connecticut law.
Connecticut law requires health insurance plans to cover chiropractic care “to the same extent” coverage is provided for services rendered by a physician.
“Aetna’s prompt and fair response to this issue means providers will be paid for covered services and Aetna’s enrollees will continue to receive the care to which they are entitled,” Jepsen said. “Everyone benefits from this cooperation.”
Chiropractors licensed in Connecticut are permitted to provide a wide range of services, such as the use of X-ray and other diagnostic technology, the administration of foods and vitamins and preventative care. If health insurance plans cover those services when provided by physicians, they also must be covered when provided by chiropractors in Connecticut.
Aetna told Jepsen the claim system will be updated to include the procedure codes for qualifying services a chiropractor can provide in Connecticut. In addition, ASHN will review eligible claims submitted since July 1 and reprocess those denied incorrectly. No estimate was available on the number of claims affected.
Since July 1, American Specialty Health Network has provided claims administration and other services for chiropractic benefits available under Aetna’s health insurance plans with the exception of Aetna’s Traditional Choice plans in Connecticut.
Tuesday, August 2, 2011
Friday, May 13, 2011
Chiropractic manipulation results in little or no risk of chest injury
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Dynamic chest compression occurs during spinal manipulation. While dynamic chest compression has been well studied in events such as motor vehicle collisions, chest compression forces have not been studied during chiropractic manipulation. In a study published online today in the Journal of Manipulative and Physiological Therapeutics, researchers quantified and analyzed the magnitude of chest compressions during typical as well as maximum chiropractic manipulation and have found them to be well under the threshold for injury.
"Results from this preliminary study showed that maximum chest compression during chiropractic manipulation of the thoracic spine is unlikely to result in injury," according to lead investigator Brian D. Stemper, PhD, Associate Professor, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI. "We performed this study to get a better understanding of the force limits of chiropractic manipulation. This information may lead to safer manipulation procedures and help to decrease the possibility of adverse patient outcomes."
In the first part of the study Professor Stemper and his co-investigators worked with two practicing doctors of chiropractic, each with a minimum of 4 years of doctoral training and at least 7 years of healthcare experience. Using a crash test dummy they measured the level of chest compression induced during "normal" chiropractic manipulation and during spinal manipulations wherein the doctors of chiropractic exerted maximum effort. They performed simulated chiropractic manipulations on the test dummy at the midback level (T7 to T8 vertebrae).
In the second part of the study, an instrumented mechanical device was used to apply and measure the forces necessary to induce chest compression in the test dummy. These forces were increased until injurious levels of force were reached. The likelihood of injury was assessed and classified using the Abbreviated Injury Scale (AIS), which is a useful classification system that has been correlated to injury thresholds during biomechanical experimentation.
In the present study, manipulations incorporating typical and maximum efforts by the doctors of chiropractic resulted in maximum chest compressions corresponding to minimal risk of AIS 1 level injuries.
As with all types of patient care, Professor Stemper cautions that "individual patient characteristics including age, degeneration, and gender" should be taken into consideration during treatment such as chiropractic manipulation.
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The article is "An Experimental Study of Chest Compression During Chiropractic Manipulation of the Thoracic Spine Using an Anthropomorphic Test Device" by Brian D. Stemper, PhD, Jason J. Hallman, PhD, and Boyd M. Peterson, DC. It will appear in the Journal of Manipulative and Physiological Therapeutics, Volume 34, Issue 5 (June 2011), DOI 10.1016/j.jmpt.2011.04.001, published by Elsevier.
Dynamic chest compression occurs during spinal manipulation. While dynamic chest compression has been well studied in events such as motor vehicle collisions, chest compression forces have not been studied during chiropractic manipulation. In a study published online today in the Journal of Manipulative and Physiological Therapeutics, researchers quantified and analyzed the magnitude of chest compressions during typical as well as maximum chiropractic manipulation and have found them to be well under the threshold for injury.
"Results from this preliminary study showed that maximum chest compression during chiropractic manipulation of the thoracic spine is unlikely to result in injury," according to lead investigator Brian D. Stemper, PhD, Associate Professor, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI. "We performed this study to get a better understanding of the force limits of chiropractic manipulation. This information may lead to safer manipulation procedures and help to decrease the possibility of adverse patient outcomes."
In the first part of the study Professor Stemper and his co-investigators worked with two practicing doctors of chiropractic, each with a minimum of 4 years of doctoral training and at least 7 years of healthcare experience. Using a crash test dummy they measured the level of chest compression induced during "normal" chiropractic manipulation and during spinal manipulations wherein the doctors of chiropractic exerted maximum effort. They performed simulated chiropractic manipulations on the test dummy at the midback level (T7 to T8 vertebrae).
In the second part of the study, an instrumented mechanical device was used to apply and measure the forces necessary to induce chest compression in the test dummy. These forces were increased until injurious levels of force were reached. The likelihood of injury was assessed and classified using the Abbreviated Injury Scale (AIS), which is a useful classification system that has been correlated to injury thresholds during biomechanical experimentation.
In the present study, manipulations incorporating typical and maximum efforts by the doctors of chiropractic resulted in maximum chest compressions corresponding to minimal risk of AIS 1 level injuries.
As with all types of patient care, Professor Stemper cautions that "individual patient characteristics including age, degeneration, and gender" should be taken into consideration during treatment such as chiropractic manipulation.
###
The article is "An Experimental Study of Chest Compression During Chiropractic Manipulation of the Thoracic Spine Using an Anthropomorphic Test Device" by Brian D. Stemper, PhD, Jason J. Hallman, PhD, and Boyd M. Peterson, DC. It will appear in the Journal of Manipulative and Physiological Therapeutics, Volume 34, Issue 5 (June 2011), DOI 10.1016/j.jmpt.2011.04.001, published by Elsevier.
Wednesday, February 16, 2011
For Back Pain, Spinal Manipulation Holds Its Own
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Source: Health Behavior News Service
If you’re suffering from chronic lower back pain, a new review of existing research finds that spinal manipulation − the kind of hands-on regimen that a chiropractor might perform on you − is as helpful as other common treatments like painkillers.
Spinal manipulation is also safe, researchers found. Ultimately, “the decision to refer for manipulation should be based upon costs, preferences of the patient and providers, and relative safety of all treatment options,” said review lead author Sidney Rubinstein, a chiropractor in private practice and a postdoctoral researcher at the VU University Medical Center in Amsterdam.
Surveys suggest that half of working Americans suffer from back pain each year. An estimated 25 percent of American adults reported that they suffered from back pain for at least a day within the last three months, according to a 2006 Centers for Disease Control and Prevention report, and lower back pain is the fifth most common reason that people go to the doctor.
Patients frequently turn to painkillers, which can cause side effects and be addictive, or to physical therapy, which is time-consuming and expensive. The new review looks at a third option − spinal manipulation.
In North America, Rubinstein said, chiropractors perform most spinal manipulation. Practitioners move their hands around a patient’s spine and joints, often producing an audible crack.
“The effectiveness of this therapy has long been controversial,” Rubinstein said. “Some proponents are slowly starting to view it as effective for chronic low-back pain. The results of this review will support that view.”
The review authors looked for randomized controlled studies, which are researchers consider as the most reliable forms of medical research. They found 26 studies − with 6,070 participants − that met their criteria for inclusion in their review, but deemed only nine studies to be of high quality.
The findings appear in the latest issue of The Cochrane Library. The journal is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The researchers found that spinal manipulation worked about as well as the other treatments. It appears to work well in particular for certain kinds of patients, Rubinstein said, including those with restricted movement in the back, those without psychological issues, and those without symptoms below the knee related to the sciatic nerve.
Spinal manipulation “appears to be no better or worse than other existing therapies for patients with chronic low-back pain,” the review says.
There is one small caveat, however. In medical research, scientists often compare a treatment to a placebo, which is difficult when you are talking about something that's difficult to fake − like spinal manipulation.
Three of the studies reviewed the kind of spinal manipulation that produces a crack sound and tried to fool some patients into not realizing they were getting a sham treatment. However, it is unclear if they succeeded, Rubinstein said. One study appeared to show that patients could distinguish whether they were getting the real thing.
So how well do the treatments − spinal manipulation and the other examined in the review − work overall? Rubinstein said studies have shown that they help about two-thirds of patients. Sti other researchers say they have a modest impact at best.
In general, most treatments for lower-back pain “aren’t all that effective, even the ones we think that work, but some people respond better than others,” said Dr. Roger Chou, a physician and researcher with Oregon Health & Science University who has studied back pain.
“Right now the best we can say is that clinicians and patients have a number of moderately effective treatment options to consider, including exercise, manipulation, acupuncture, yoga, massage, cognitive behavioral therapy and some of the analgesic medications, and that it should be a decision between the clinician and patient,” Chou said. “In general, I think exercise is a preferred option since it has a lot of other health benefits.”
Dr. Tim Carey, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, said that many patients try several treatments, of which spinal manipulation is just one approach.
“We do not have a good sense of how manual therapy fits in an exercise regimen in a patient who is also taking medication, just as an example,” said Carey, who studies back pain. “While manual therapy seems to be an option for chronic low back pain, the evidence at present does not support a role as a preferred option.”
TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required.
Source: Health Behavior News Service
If you’re suffering from chronic lower back pain, a new review of existing research finds that spinal manipulation − the kind of hands-on regimen that a chiropractor might perform on you − is as helpful as other common treatments like painkillers.
Spinal manipulation is also safe, researchers found. Ultimately, “the decision to refer for manipulation should be based upon costs, preferences of the patient and providers, and relative safety of all treatment options,” said review lead author Sidney Rubinstein, a chiropractor in private practice and a postdoctoral researcher at the VU University Medical Center in Amsterdam.
Surveys suggest that half of working Americans suffer from back pain each year. An estimated 25 percent of American adults reported that they suffered from back pain for at least a day within the last three months, according to a 2006 Centers for Disease Control and Prevention report, and lower back pain is the fifth most common reason that people go to the doctor.
Patients frequently turn to painkillers, which can cause side effects and be addictive, or to physical therapy, which is time-consuming and expensive. The new review looks at a third option − spinal manipulation.
In North America, Rubinstein said, chiropractors perform most spinal manipulation. Practitioners move their hands around a patient’s spine and joints, often producing an audible crack.
“The effectiveness of this therapy has long been controversial,” Rubinstein said. “Some proponents are slowly starting to view it as effective for chronic low-back pain. The results of this review will support that view.”
The review authors looked for randomized controlled studies, which are researchers consider as the most reliable forms of medical research. They found 26 studies − with 6,070 participants − that met their criteria for inclusion in their review, but deemed only nine studies to be of high quality.
The findings appear in the latest issue of The Cochrane Library. The journal is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The researchers found that spinal manipulation worked about as well as the other treatments. It appears to work well in particular for certain kinds of patients, Rubinstein said, including those with restricted movement in the back, those without psychological issues, and those without symptoms below the knee related to the sciatic nerve.
Spinal manipulation “appears to be no better or worse than other existing therapies for patients with chronic low-back pain,” the review says.
There is one small caveat, however. In medical research, scientists often compare a treatment to a placebo, which is difficult when you are talking about something that's difficult to fake − like spinal manipulation.
Three of the studies reviewed the kind of spinal manipulation that produces a crack sound and tried to fool some patients into not realizing they were getting a sham treatment. However, it is unclear if they succeeded, Rubinstein said. One study appeared to show that patients could distinguish whether they were getting the real thing.
So how well do the treatments − spinal manipulation and the other examined in the review − work overall? Rubinstein said studies have shown that they help about two-thirds of patients. Sti other researchers say they have a modest impact at best.
In general, most treatments for lower-back pain “aren’t all that effective, even the ones we think that work, but some people respond better than others,” said Dr. Roger Chou, a physician and researcher with Oregon Health & Science University who has studied back pain.
“Right now the best we can say is that clinicians and patients have a number of moderately effective treatment options to consider, including exercise, manipulation, acupuncture, yoga, massage, cognitive behavioral therapy and some of the analgesic medications, and that it should be a decision between the clinician and patient,” Chou said. “In general, I think exercise is a preferred option since it has a lot of other health benefits.”
Dr. Tim Carey, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, said that many patients try several treatments, of which spinal manipulation is just one approach.
“We do not have a good sense of how manual therapy fits in an exercise regimen in a patient who is also taking medication, just as an example,” said Carey, who studies back pain. “While manual therapy seems to be an option for chronic low back pain, the evidence at present does not support a role as a preferred option.”
TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required.
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