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

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.