Performance Measurement:
Performance measurement promotes informed choices on the part of health plan members by helping to identify two key components of the care patients receive.
First, the pattern of diagnostic and treatment services is compared to care management that is consistent with the recommendations of broadly accepted evidence-based guidelines. In addition, a chiropractor’s “care pattern” is compared to same-specialty providers in their same geographic region.
The second part of performance measurement includes a cost assessment. The average cost of health care services for each chiropractor is compared with the average cost of all same-specialty practitioners in a geographic region. This measure supplies information about the probability of the financial obligations, including deductible and copayments, likely to be incurred as a result of a chiropractor’s care pattern.
Visits:
The number of visits provides information about how long patients seeing a particular chiropractor remain under treatment before complaints are either resolved or can be self-managed, or an appropriate referral is made.
Medica members treated by a chiropractor whose care patterns are aligned with “best practices” generally average eight or fewer visits. This is because most patients respond rapidly to treatment (i.e., more than 50 percent respond within 1-2 weeks), and the majority respond within 4-6 weeks. Additionally, patients whose conditions are not likely to respond to chiropractic care can usually be identified within the first week or two of care and referred on to an appropriate care provider.
X-rays:
For most individuals seeking treatment for spine-related complaints, X-rays are not routinely indicated. Chiropractors whose care patterns are aligned with “best practices” will use the information from a patient’s history and examination to selectively determine whether an X-ray is likely to be helpful in determining the cause of complaints.
Passive Therapies:
Passive therapies are those treatments typically applied directly by the chiropractor, or an assistant, to a patient. Common examples include hot/cold packs, massage, ultrasound, electrical stimulation and traction.
Health care providers whose care patterns are aligned with “best practices” generally provide an verage of one-and-one-half or fewer passive therapies per visit. This is because most patients find limited benefit with their use and/or some passive therapies (i.e., hot/cold packs) can be used primarily at home.
Evidence-based guidelines usually recommend the limited application of passive therapies during the initial stage of care when complaints are most acute. These same guidelines typically encourage a rapid transition from use of passive therapy toward more active self-care measures such as resumption of normal activities, modified exercise, etc.
Total Therapies:
Total therapies are a combination of active and passive therapies. Active therapy is performed by the patient with direct supervision from the health care provider. Common examples include various types of supervised exercise (stretching, strength and endurance). Passive therapies are described above.
Health care providers whose care patterns are aligned with “best practices” generally provide an average of two-and-a-half or fewer total therapies per visit. This is because most patients find limited benefit with their use and/or some passive therapies (i.e., hot/cold packs) can be used primarily at home. It addition, most patients only require limited supervision/instruction before exercise (active therapy) can be performed at home.
Cost Measures:
The average cost of health care services for each chiropractor is compared with the average cost of all chiropractors in a geographic region. This measure provides an estimate of the costs that are likely to be incurred as a result of the chiropractor’s care patterns.
The current evidence indicates that there is no positive association between more expensive types of care vs. more efficient care for spine-related disorders. In fact, there is some concern that more expensive care may represent an excess use of services, which is not supported by broadly accepted guidelines for patient care.