Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare

Seven months into the evaluation contract, Brandeis had completed site visits/interviews with the four demonstration regional CMS claims carriers, as well as with the respective American Chiropractic Association chapters. The OMB package for the proposed mailed satisfaction survey of 2,000 beneficiary recipients of expanded chiropractic services across the four demonstration regions was put into the 6-month review circulation for OMB approval in February 2006. OACT has just reviewed and approved, without revision, the contractor's proposal for the budget neutrality determination, as contained within the drafted Design Report. Currently underway is finalization of plans for impending selection of the four control regions and for the analysis of Medicare Claims data. The final phase (Phase Two) has been extended nine months, until June 30, 2010. An interim, letter-format Report to Congress, covering the initial 18 of the 24 months of the demonstration, was sent to Congress in October 2008. A separate report on Budget Neutrality was provided in winter 2009. The Final Report to Congress, covering the full 24 months of demonstration claims, is in final stages of circulation. Update 12-01-2010: This Evaluation contract ended on June 30, 2010. The final Report to Congress (of June 2009)was sent in January 2010. Summary of findings: The demonstration had a slow ramp-up in year one due to billing system difficulties, with improvement in year two. Overall, only 40% of eligible chiropractors participated. Surveyed beneficiaries were highly satisfied with services and reported good symptom relief. Almost 70% had additional insurance that covered some chiropractic care. Among users of any expanded care, chiropractic visits increased by 60% overall, and Medicare costs related to expanded services increased by $34.8 million. Budget neutrality analysis showed that - among users of any chiropractic services for neuromusculoskeletal conditions - total Medicare costs increased by $50 million overall for the expanded care regions, when compared to standard chiropractic users' total Medicare costs in matched control counties. Nearly all of the increased costs occurred in urban non-HPSA areas and in Chicago, Illinois and suburbs. WEB URL: http://www.cms.hhs.gov/Reports/Downloads/Stason_Chiro_RTC_2010 .