Economic Impact of Adhering to Care Guidelines for Non-surgical Spine Care: The Spinal Frontier

Objective: Care guidelines from the American College of Physicians/American Pain Society for treating non-surgical spine-related disorders (SRDs) recommend conservative treatments such as manipulation and exercise while avoiding costly imaging and injections. SRDs represent a sizeable portion of US healthcare expenditures. Promoting guideline adherence may represent both a noteworthy cost driver and a public health action. This study compares costs of treating non-surgical SRDs between providers who are guideline adherent versus less adherent providers. 

Methods: We utilized data from a US commercial insurer to identify non-surgical SRD episodes of care.  Primary Spine Providers (PSP)  were categorized on adherence to care guidelines and three comparison groups were created: providers meeting the criteria in 100% of their episodes (PSP 1), providers meeting the criteria in 50-99% of their episodes (PSP 2), and providers meeting the criteria in under 50% of their episodes (PSP 3).  Propensity score matching was employed to separately match episodes associated with PSP 1 providers to episodes of PSP 2 and PSP 3 providers. Episode costs between the two sets of matched cohorts was compared using generalized linear models. 

Results: There were statistically significant savings of $31.89 per episode for PSP 1 over PSP 2 providers and savings of $61.69 per episode when comparing PSP 1 to PSP 3 providers, representing a 5% and 8% per-episode savings. 

Conclusion: These findings suggest that members with non-surgical spine disorders who are treated by providers that consistently follow recommended guidelines have lower episode costs than those treated by less adherent providers.