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APHA Scientific Session and Event Listing

Recorded presentation

William B. Stason, MD, MSci, Christopher Tompkins, PhD, Donald S. Shepard, PhD, Jeffrey Prottas, PhD, Grant Ritter, PhD, and Timothy C. Martin, PhD. Schneider Institute for Health Policy, Heller School, Brandeis University, 415 South St,, Mailstop 035, Waltham, MA 02454, 781 736 3957, wbstason@comcast.net

Medicare began a two-year demonstration of expanded coverage for chiropractor services on April 1, 2005 in four regions of the country (Illinois-Iowa, Maine, New Mexico, Virginia). In these areas, Medicare covers a variety of neuromusculoskeletal (NMS) diagnoses and, for these, a broad range of evaluation and management (E&M) services, procedures, x-rays, and laboratory tests. Brandeis University is evaluating this demonstration with respect to utilization of covered chiropractic services by patients and the resulting net costs to the Medicare program. Under a budget neutrality provision of the enabling legislation, chiropractors' fees will be reduced in 2010-2011, if necessary, in order to recoup any net increase in Medicare expenditures. The evaluation includes: (1) site visits to each demonstration region to examine issues that arise during implementation for chiropractors and Medicare carriers; (2) a patient survey to determine the types of clinical problems for which Medicare beneficiaries are seeking chiropractor services, their clinical responses to these, and their satisfaction with services received; (3) analyses of claims data to examine utilization and costs of chiropractor services and other Medicare services for the NMS diagnosis; and (4) an analysis of budget neutrality. Claims analyses will use propensity-score matching to compare patients in demonstration areas to those in comparison areas. The presentation will focus on the methods being used to evaluate this demonstration, the integration of the four components of the evaluation, and the implications of these approaches for interpreting the outcomes of the demonstration.

Learning Objectives: At the end of the presentation, the participant will be able to

• Describe the design of Medicare's Demonstration that provides expanded coverage for chiropractic services.
• Describe the objectives and methods of the evaluation being performed of this demonstration.
• Describe the current status of the evaluation and its timetable for completion.

Keywords: Chiropractic, Medicare

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation