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Lousy back pain care – it’s not just work comp

What’s changed in treating back pain over the last decade?

More narcotics and fewer NSAIDs.  More referrals to specialists, less treatment by primary care docs.  More MRIs and CTs.  

A really illuminating article just published in JAMA provided those insights and more, concluding “Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care.”

Like 29% of patients prescribed narcotics.

In other words, more care, delivered by more expensive providers, with higher risks, despite no evidence it improves results.

Not only do we have a looooong way to go, it’s getting longer every day…


5 thoughts on “Lousy back pain care – it’s not just work comp”

  1. Thus the reason we need something like IPAB…at both the federal and state levels

    1. IPAB is simply a payment advisory board, and is tasked with achieving savings within the Medicare system.

      The board can affect changes to rates as they relate to providers and hospitals, but these are based on actuarial targets provided by the Chief Actuary from CMS.

      These decisions will not necessarily be based on clinical guidelines, as there is no requirement for any of the IPAB members to be clinicians.

      1. Ramnik, welcome to MCM. Thanks for the clarification. I’d note that Congress has frequently over-ridden appropriate clinically-based decisions, processes, and entities, a situation driven in large part by donors’ ability to influence elected officials. Given the GOP’s refusal to appoint any members (they have several slots) it is clear they continue to support providers. That is why IPAB was created, and why its role is critical to control Medicare spending. While there may well be clinicians on the board, the presence or absence of clinicians does not mean decisions will – or won’t – be based on clinical guidelines. Coverage determinations do not require clinicians occupy the role of decision maker.

  2. For those of us in managed care how do you begin a dialogue with claims professionals regarding opiod mismanagement?

  3. Obviously it is high time to get back to high touch, low cost CHIROPRACTIC Care.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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