Another Look at the Budget Neutrality of the Medicare Chiropractic Services Demonstration: Preliminary Findings

In 2005-2007, The Centers for Medicare and Medicaid Services conducted the “Demonstration of Expanded Coverage of Chiropractic Services under Medicare” in selected counties in five states. The official evaluation showed that the project was essentially budget-neutral in four states. In Illinois however, Medicare expenditures were approximately $50M higher for beneficiaries who used chiropractic. We are analyzing Medicare claims and other administrative data before, during and after the demonstration to re-evaluate the budget neutrality of the demonstration project. Specifically, our aims are three-fold: 1) To evaluate details of services provided to chiropractic users under the demonstration project, we are determining the specific source/s of increased costs, and describing and quantifying differences among demonstration and comparison sites in the volume and cost of specific services provided to chiropractic users, by procedure code. 2) To describe contextual geographic patterns of utilization and identify outliers among demonstration sites, we are evaluating for variations by county throughout the US in the volume and cost of all services (including chiropractic services) provided to patients with neuromusculoskeletal conditions during the demonstration. 3) To evaluate for secular trends in Medicare expenditures and for differences between demonstration and comparison sites in longitudinal trends for expenditures, we are describing and quantifying differences in Medicare expenditures, by procedure code, for the two-year period preceding the demonstration and the two-year period following conclusion of the demonstration.

In this presentation, we will describe our research methods in greater detail, report our preliminary findings, and discuss potential policy implications for chiropractic services under Medicare.