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Comparing Costs and Utilization Between Provider Types for Back and Neck Pain: A Cross-Sectional Study.

Forest S Kim¹, David J Kahle², Neil S Fleming¹

¹Robbins Institute for Health Policy & Leadership, Baylor University, Waco, Texas.

Journal of Manipulative and Physiological Therapeutics

|September 12, 2025

Summary

This summary is machine-generated.

Providers using standardized treatment pathways, like Airrosti (AP), showed reduced costs and utilization for spinal pain patients compared to non-AP providers. This suggests adherence to clinical guidelines can lower healthcare expenses and improve efficiency.

Keywords:

Back pain Chiropractic Episodes of care Health care costs Health care utilization Neck pain Orthopedics Physiatry Physical therapy specialty Primary care

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Area of Science:

Health Economics
Musculoskeletal Disorders
Healthcare Management

Background:

Comparing treatment expenditures and utilization for spinal pain is crucial for healthcare cost containment.
Licensed doctors of chiropractic or physical therapy working for Airrosti (AP) represent a specific model of care delivery.
Non-AP providers (NAP) encompass diverse specialties, necessitating a granular comparison.

Purpose of the Study:

To compare treatment expenditures and utilization between Airrosti (AP) providers and non-AP providers (NAP) for back and neck pain.
To analyze differences across five distinct NAP types: orthopedic specialists, physiatrists, physical therapists, primary care providers, and chiropractors.
To identify which provider types are associated with higher or lower costs and utilization patterns.

Main Methods:

A retrospective, claims-based, cross-sectional study design was employed.
Utilized five years of claims and enrollment data from Texas.
Propensity scores with inverse probability weighting controlled for selection bias in comparing AP and NAP across episodes of care for back and neck pain.

Main Results:

Orthopedic specialists, physiatrists, and physical therapists generally had higher costs and utilization than AP, with exceptions noted.
Primary care providers exhibited lower costs and utilization than AP, with no significant difference in hospitalization rates.
AP demonstrated cost and utilization patterns most similar to chiropractors, though AP utilized advanced diagnostic imaging more frequently.

Conclusions:

Standardized treatment pathways, as used by AP, were associated with reduced variation and costs for spinal pain patients.
Adherence to clinical guidelines, discouraging early diagnostic imaging and surgery, may explain the cost and utilization differences observed.
The findings suggest that standardized, guideline-adherent care pathways can lead to more efficient and cost-effective treatment for spinal pain.