Some of the information for low-back programs was not self-reported by the clinic. These items include:

• average cost range for services used to treat chronic low-back pain
• percent of patients who receive surgery

Medica commercial claims data was used to compile these measurements, excluding the Minnesota Comprehensive Health Association (MCHA). Members with low-back pain were assigned to a clinic when they had four or more unique visits to a specific clinic. A unique visit was defined as at least one claim on an individual date of service from the provider who rendered the service. The last visit to the clinic during the episode must have occurred after Jan. 1, 2008. Members with fewer than four visits to an identified provider within a 12-month period were excluded from the analysis.

Percent of patients who receive surgery
The percent of patients who receive surgery after program completion was calculated based on assigned members with low-back pain who received a surgical procedure after completing the low-back pain program, along with clinic self-reported data. The range was calculated using a combination of these two separate data samples.

Comprehensive low-back program
Includes a structured program that tracks patients throughout the program and follows specific protocols. The program monitors the patient's functional status and long-term outcomes. Programs generally include a relapse-prevention program, so patients know how to manage symptoms if they do come back. Information was self-reported by clinics via Medica's low-back survey.

Cost range
The cost range shown reflects the estimated cost of physical therapy services, including services such as ultrasound, injections, electrical stimulation, and other services. Costs were calculated for the low-back episodes attributed to a clinic. The clinic's cost range was determined by calculating their 20th and 80th percentiles.

Cost estimates are based on contract rates for the Medica Choice^® network and may not reflect the costs under plans that use another network. In addition, costs do not reflect benefit design or member liability. Costs for individual cases will vary depending on the severity of illness and/or complexity of the procedure performed.