Conservative Care/Chiropractic. A contemporary approach to managing care and lowering costs! A contemporary approach to managing care and lowering costs! Presenter: Dr. Ronald J. Farabaugh Our mission: To obtain the best outcome, in the shortest period of time, with the lowest cost! Topic: “Research and other data” Why Choose Chiropractic First?

Presented by Dr. Ronald J. Farabaugh Past Chairman-Council on Chiropractic Guidelines and Practice Parameters (CGPP) Past President-Central Ohio Chiropractic Past President-Ohio State Chiropractic Association (OSCA) President: Ohio State Chiropractic Board ODG Advisory Board ACA Wikipedia Committee ACA Research Committee Malpractice Expert Fellow in International College of Chiropractors Ronald J. Farabaugh, DC

Q: Can chiropractic achieve better outcomes with less costs? A: YES!! “I don’t believe in Chiropractic!! An evidence-based, cost-effectiveness- related response.

Chiropractic Influence on outcomes and cost. What do others say? 1.ACP 2.AMI 3.Optum/UHC 4.Keeney 5.Cleveland Clinic 6.University of Pittsburgh 7.JAMA 8.Sanford Health

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society 2 October 2007 | Volume 147 Issue 7 | Pages acutespinal manipulationchronic or subacute interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality)

CLINICAL AND COST OUTCOMES OF AN INTEGRATIVE MEDICINE IPA Sarnat, Winterstein JMPT June 2004 Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions 58.4% hospital days 43.2% outpatient surgeries and procedures 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA

CLINICAL UTILIZATION AND COST OUTCOMES FROM AN INTEGRATIVE MEDICINE INDEPENDENT PHYSICIAN ASSOCIATION: AN ADDITIONAL 3-YEAR UPDATE Sarnat, Winterstein, Cambron JMPT May 2007 Results: Clinical and cost utilization based on member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions 59.0% hospital days 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame.

Optum Health/UHC

Optum’s Optimal Care Pathway!

Optimal Care Pathway! A follow up Optum study discover even more important data… Not only should chiropractic be encouraged initially, but the first ten days are critical if you want to lower costs even more!!

Early Use of a DC… Results. 1,885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The multivariate model's AUC was 0.93 (95% CI ), indicating excellent ability to discriminate between workers who would versus would not have surgery. Keeney Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Keeney et al. Spine 2012 Dec 12.

Spinal Column Cleveland Clinic Low Back Pain Work Flow Source: Spinal Column

University of Pittsburgh

AMA and Chiropractic!

AMA supports Chiropractic!

JAMA Recommends Chiropractic for Low-Back Pain some people benefit from chiropractic therapy or acupuncture According to the JAMA Patient Page of April 24, 2013 on “Low Back Pain”, while many treatments are available for low back pain and often exercises and physical therapy can help, some people benefit from chiropractic therapy or acupuncture. JAMA continues that surgery is not usually needed but may be considered if other therapies have failed. Source: JAMA Apr 24;309(16):1738. doi: /jama JAMA patient page. Low back pain. Goodman DM, Burke AE, Livingston EH.

Sanford Health Own 39 hospitals and 225 clinics in the upper midwest (ND, SD, MN, and MT). Epic’s “One Chart” EMR Weekly training newsletter: New Best Practice Advisory (BPA). Pop-up warning: in absence of red flags MRI should not be performed until 4-6 weeks of PT or Chiropractic Therapy completed. Pop-up warning: in absence of red flags MRI should not be performed until 4-6 weeks of PT or Chiropractic Therapy completed. Just told 1360 physicians that PT or DC care is the preferred tx of LBP!!

What has been the result of the decline of chiropractic usage? Answer: doubling of drug intake! Is that the direction we really want to go?

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