How CICN Saves People Money
Updated: May 13, 2020
Care for spine and joint related conditions is inflated. A CICN independent analysis in 2018-2019 showed that costs associated with "usual care" (defined as state averages) are 27-34% higher than they should be. For patients, insurance companies, and employers this means that for every $100 spent, $27-34 is wasted.
Many of us quickly point fingers to healthcare systems and providers. However, provider decisions are not responsible for most of the unnecessary spend. The greatest unnecessary expenses are not due to provider decisions, rather they are a consequence of single-disciplinary treatment centers and poorly aligned healthcare groups. Let me walk you through an example.
John Doe is working in the yard one morning. When he lifts a wheel barrow he feels a sudden pain in his back. He calls his primary care provider (PCP) (over 60% of people see a PCP first). The PCP sees him the next day, performs an exam, and gives him a medication(costs $200). Two weeks go by and John continues to have pain. He calls his PCP. His PCP sends a referral to an orthopedic physician (ortho). John gets an appointment with the ortho 4 days later. The ortho performs an exam, orders x-rays, and recommends physical therapy (cost $350 for ortho visit & x-rays). John goes to PT. The PT performs an exam and recommends 12 visits over 4 weeks (cost 1,000). In the third week John is feeling 50% better, but still is not able to fully function. His neighbor recommends a chiropractor. John sees the chiropractor, who performs an exam and recommends 6 visits while undergoing physical therapy (cost $400).
Sure, I'm using an example of somebody being moved through the health system. However, by "usual care" standards this care pathway is not unusual. The average number of independent providers seen for acute low back pain is two. In acute and longer lasting low back pain that progresses to an orthopedic physician, such as what John experienced in this example, the average number of independent providers seen is four.
Here's an important point. As a general rule, when more than one independent provider is involved in a single episode of pain, unnecessary expenses occur. In this example, John had four independent examinations performed that were paid for and took an hour of his time each. He was recommended four different treatment plans. The total duration of the care pathway was 6-7 weeks. John had to drive to 20 different appointments. He likely had 4-5 n