Comparison of management costs of neck pain according to pattern of care: The North Carolina state health plan for teachers and state employees, 2000-2009

The purpose of this paper is to compare and contrast the management costs of neck pain according to pattern of care. The study includes the claims for 664,000 covered lives in North Carolina from 2000 to 2009. For uncomplicated neck pain (UNP), 2,795,046 claims met the inclusion criteria; for complicated neck pain (CNP), 529,318 claims met the inclusion criteria. Fifteen care patterns involving doctors of chiropractic (DCs), medical doctors (MDs), and physical therapists (PTs) were identified. We computed medical, pharmaceutical, and overall charges according to pattern of care, by patient and claim separately for each year in order to detect trends over time in use and costs. Over the decade, total allowed charges more than doubled for UNP and more than tripled for CNP; average charges increased by 26% for UNP and by 37% for CNP. Mean and median per-patient and per-claim charges associated with both UNP and CNP varied significantly by pattern of care during the 2000-2009 decade. In general, patterns of care involving multiple providers and referrals incurred the largest charges, while patterns of care involving single or non-referral providers incurred the least charges. For both UNP and CNP, MD referrals were much costlier than DC referrals, and MD-PT care with referrals much more expensive than MD-DC care with referrals. For UNP in 2009, care involving MDs was on average $933 (or 47.3%) more expensive than care with DCs. For CNP in 2009, MD care was on average $5298 (or 197%) more expensive than care with DCs.