University of Pittsburgh Medical Center:
Chiropractic and Medical Options before Back Surgery
Dear Patients & Friends:
Beginning January 1, 2012 the University of Pittsburgh Medical Center Health Plan will implement new guidelines regarding treatment of chronic low back pain. Before this large health plan will authorize back surgery, patients must have tried and failed 3-months of conservative care including physical therapy, chiropractic, and medication, according to a letter to providers, and guidelines available on the UPMC website. The UPMC network includes 15 hospitals in western Pennsylvania and 3 abroad.
Also patients must participate in the UPMC Health Plan’s Low Back Pain health coaching program that uses a web-based tool which helps them understand the pros and cons of surgery and high-tech radiology. Patients must receive conservative chiropractic and physical therapy before high-tech imaging such as CT or MRI will be authorized.
The guidelines nearly match care we recommend for our patients, and mirror the original 1994 U.S. Agency for Healthcare Policy and Research guidelines, extending them to treatment for chronic low back pain.
Why this approach? Most cases of even chronic low back pain will begin to respond to chiropractic within just 2-4 weeks of starting treatment. Because even severe back pain often resolves without more expensive imaging and treatments including surgery, the cost savings to insurance companies and society may be huge. Generally, conservative treatments are also much safer.
When a patient does not respond to initial conservative care, or when indicated by “red flags,” we will review other care options. These include referral for CT or MRI, and referral to your doctor or another specialist for lab tests, medications, or injections.
The model of chiropractors working with medical doctors to improve patient outcomes is a relatively new and welcome change in the healthcare industry. In addition to the UPMC guidelines, shining examples of cooperation include chiropractic in Armed Services treatment facilities such as the National Navel Medical Center at Bethesda, at Veterans Administration facilities, and at a growing number of hospitals and group practice centers throughout the U.S.
Rob Leach, DC, MS, CHES, FICC(H)
The announcement of the 2012 UPMC health plan change may be found at: http://www.upmchealthplan.com/pdf/Dec_2011_PPU.pdf
The UPMC Guidelines for surgical management of chronic low back pain are posted online at: http://www.upmchealthplan.com/pdf/PandP/MP.043.pdf
To read an interview with Bill Morgan, B.S., D.C., who works at the chiropractic unit of the National Navel Medical Center in Bethesda, Maryland: http://www.healthy.net/scr/interview.aspx?Id=307
In 2004 the Department of Veterans Affairs first announced 26 sites where veterans could receive chiropractic, and the number has grown since that time: http://www.va.gov/opa/pressrel/pressrelease.cfm?id=837
More and more US Hospitals have chiropractic staffs, and even work in emergency room departments: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=15395
Across the U.S. and even in Canada chiropractors are joining in collaborative practice arrangements including group practices and work in community health centers: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839934/