The role of alternative medical providers for the outpatient treatment of insured patients with back pain.

STUDY
DESIGN: Analysis of health insurance claims from 2 large Washington State companies.
OBJECTIVE: To evaluate the prevalence and cost of complementary and alternative medicine (CAM) provider use for back pain treatment. SUMMARY OF BACKGROUND DATA: Washington State requires all commercial insurance to cover licensed CAM providers.
METHODS: Outpatient claims for the treatment of back pain were analyzed by the International Classification of Disease-9 codes and provider type. The number of visits and expenditures associated with different forms of treatments were calculated.
RESULTS: Back pain accounted for 15% of all outpatient visits, and these companies spent more than $52 million on 652,593 claims submitted by 104,358 adults. Most people used only CAM (43%) or only conventional providers (45%) for back pain treatment, with merely 12% using both. Patients who saw only CAM providers had fewer comorbidities than the other 2 groups and made approximately twice as many visits as "conventional only" users (median 4 vs. 2). Average amount allowed per outpatient low back pain claim was lower for CAM visits (mean $50, SD $28) than for conventional visits (mean $128, SD $173). Total outpatient costs for the treatment of back pain were highest for the group using both CAM and conventional care (mean $1079, SD $1185), and lowest for the group using CAM only (mean $342, SD $429).
CONCLUSION: Many people with back pain use only CAM for their treatment. Although less expensive, this group also appears to be less severely ill. Because of the high prevalence of this condition, cost-effectiveness studies that include CAM therapies are still warranted.