Medicare Bill Upgrades Chiropractic Coverage

Over the years, chiropractic care and physical therapy have respectively ranked one-two when it comes to customer satisfaction compared to services provided by primary care physicians (PCP). The high marks came from sources like Consumer Reports and American Journal of Public Health and it doesn’t stop with the high value patients place on chiropractic medicine. Taxpayers and healthcare consumers with Medicare coverage learned back in 2015 from the Journal of the American Board of Family Medicine that chiropractic care was apparently saving $83.5 million a year in reduced Medicare patient visits to personal care physicians to treat neck and back pain.

Fewer visits to mainstream medical providers in favor of chiropractic medicine says a lot about patient loyalty and which is the most cost-efficient option. Imagine the impact on Medicare if other provisions of chiropractic care were covered beyond subluxation corrections through manual manipulation of the spine. 

On April 7, 2022, a bill was introduced in the U.S. Senate that “expands Medicare coverage of chiropractic services to include ALL SERVICES provided by chiropractors.” That legislation is the Chiropractic Medicare Coverage Modernization Act of 2022 (S4042), which was immediately referred to the Finance Committee whose oversight includes all Medicare-related legislation. This joins a companion bill in the House of Representatives (H.R. 2654), both with significant support, according to the American Chiropractic Association (ACA), which, in the aftermath of the Senate Bill, reported this provided “an added sense of credibility to the cause.” 

Is there any indication this could become “a source of partisan squabbling,” as has too often been the case in both chambers over the last several years? It is too early to tell or to label what would be a boon for chiropractic care as a liberal or conservative issue.

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Medicare beneficiaries want to lead active lives, but as we age musculoskeletal problems become more common. Access to chiropractic’s safe, patient-centered and evidence-based nondrug approach to back pain, neck pain and other musculoskeletal conditions provides options to those who wish to reduce or avoid pain medications and surgery. —American Chiropractic Association (ACA) President Michele Maiers, DC, MPH, PhD
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The introduction of the Senate Bill after what the ACA termed “an identical bipartisan-supported bill” in the House is regarded by the largest professional chiropractic organization in the United States as an attempt to “modernize Medicare coverage and better meet the needs of today’s seniors by increasing access to services provided by doctors of chiropractic.” The original four co-sponsors this legislation are as bipartisan as you can get— two Democrats and two Republicans — and the House Bill has accumulated 130 co-sponsors from both parties.

It comes on the threshold of when the number of Medicare-eligible Americans 65 and older is expected to increase by an estimated one-third over the current 60 million with the last of the legion of Baby Boomers. Medicare beneficiaries are currently covered for only one chiropractic service—manual manipulation of the spine—and forced to pay for additional services out of pocket or to seek those services from a different type of provider, requiring more time, travel and expense.

Coverage was established under the Medicare program for beneficiaries to receive chiropractic care was established in 1972 as an amendment to the Social Security Act. Fifty years later the wording in the Senate Bill describes why this change in coverage is essential: “Today, due to positive evidence-based outcomes and cost effectiveness of the services provided by doctors of chiropractic, private coverage for chiropractic services has evolved and State licensure for chiropractors has advanced to meet patient needs and health outcomes.”

Customizing Treatment of Neck and Back Pain

At Montvale Health Sport + Spine we have a coordinated approach to treating neck and back pain that has virtually all the symptoms (and conditions from which they arise) covered. Our treatments are obviously influenced by the symptoms of our patients, but our focus is on the root cause of the pain with symptoms serving as a map that allows us to reach the destination of improved spinal health. We prioritize treatment that brings relief without prescription meds or invasive surgery, facilitated by our interdisciplinary team of chiropractors, physical therapists, acupuncturists and pain-management physicians overseen by a Medical Director certified in Internal and Emergency Medicine.

Such a team of professionals in multiple healing arts is essential for allaying any of the following conditions that are culprits behind neck and back pain:

√ Degenerative Disc Disease

√ Herniated Discs

√ Osteoarthritis 

√ Sciatica

√ Scoliosis

√ Spinal Stenosis

√ Spondylolisthesis

√ Spondylosis

We’re talking about the entire spine, from the neck (cervical) to the lower back (lumbar) and all muscles, nerves, tendons and ligaments associated with the spinal cord, an extension of the central nervous system, and cushioning intervertebral discs. 

The aggregate of all Americans suffering from any of these conditions, whether the result of injury, illness or deterioration from misuse or aging, number in the tens of millions. Take spinal stenosis, which exerts painful, often numbing, pressure on the spine due to narrowing of spaces in the spine itself. As many as half a million U.S. residents have the symptoms of spinal stenosis, which are the most common in the high and low extremes of the spine: neck/shoulder region and low back. As many as 7 million suffer from scoliosis, an abnormal curvature of the spine that often strikes during childhood. Each year as 20 out of every 1,000 Americans are diagnosed with disc herniation, the National Institute of Health (NIH) reported in January of this year.

The location of the pain, discomfort or numbness may not be in the spine itself but assuredly emanates from there. Sciatica, for example, may originate in the lower back but you might feel it in your legs. As is the case with these other conditions, there are various treatment options. For sciatica, they may include acupuncture, chiropractic, spinal decompression therapy, or massage therapy. Customized treatment plans may be called for in treating most of these common causes of neck and back pain. 

Although many back issues are blamed on overuse or abuse, it is often a sedentary lifestyle or relative inactivity— too much sitting or poor posture when walking or standing— that is responsible for the traditional “bad back.” 

In fact, the pandemic, which may not be in our rearview mirror yet, is a lesson in how underuse often trumps overuse when it comes to neck and back pain. We covered some of the “posture busters” during the height of COVID in 2020 when millions of people nationwide stayed home to work and shelter. Sitting itself is a type of overuse injury if you are anchored to a chair or desk for hours at a time. Any position that requires an extreme forward position of the head and shoulders, as is often the case with working with a computer, puts a lot of stress on the neck, hunches the shoulders, twists the torso and stresses the upper back.

Although conditions like degenerative disc disease are regarded as part of the aging process, poor posture and too much sitting can accelerate most of the conditions behind neck and back pain. That includes other degenerative conditions like osteoarthritis.

 

Time Heals All Wounds, but Not Herniated Discs

It’s called both a disc and a disk. And it is even defined the same in most dictionaries. It can be slipped, ruptured, bulging, prolapsed and compressed, but our preference is to label it herniated— a herniated disc.  It is often very painful, with relief sought by surgery, medication, chiropractic physical therapy and even acupuncture. At Montvale Health Sport + Spine we offer a customized treatment plan with an emphasis on noninvasive.

Detection of a herniated disc may come about in various ways, but the most common and reliable are via a neurological examination or MRI imaging, CT Scan or other procedures. Usually, a physician will make an accurate diagnosis by a combination of medical history and a physical exam. Typical elements of such an exam are testing of muscle strength, reflexes, walking pattern and sensitivity to pressure, vibration or touch.

Before you get to a diagnosis, there are a number of symptoms — some surprising— that should send you to a physician or a specialist. Although associated with lower back pain that may extend deep into the buttocks and down the leg, it’s all about where the herniated disc is located. It is possible, for instance, that a shooting pain in the calf or foot is a symptom of a herniated disc low on the back. Since the discs of the spine run from your neck to the lumbar (lower back) region, shoulder and arm pain may be a symptom of a herniated disc at or just below the neck. Coughing or sneezing may send jolts of pain anywhere on your body.

Other symptoms include numbness or muscle weakness, causing you to stumble when walking or struggle when lifting or holding items.

Aging Greatest Risk for Herniated Disc

A herniated disc tends to evolve through years of wear and is therefore age-related. Among the most common factors behind herniated discs are an inactive lifestyle, overweight, sitting for extended periods of time and a sudden and dramatic intensity in exercise and activity rather that working gradually up to that level. Smoking is often cited as a risk factor because it weakens your immune system and transitions into a sedentary lifestyle.

Discs are often described as the shock absorbers of the spine, because they are flexible and thickly soft inside with a hard, protective barrier around them. However, many of those age-related factors transform those shock absorbers into shocks of pain when the barrier dries out, cracking and rupturing, thereby allowing the substance to leak out and intrude into the spinal nerves, harbingers of pain. 

Although herniated discs may occur high, low or in the middle of the spine, they are most common in the lumbar region from beneath your spine to the hips. Symptoms increase when you’re active and improve when resting. And yet resting does not guarantee freedom from pain, with herniated discs result in suffering through sleepless nights due to pain and numbness.

 There is relief to be achieved through physical therapy, chiropractic, acupuncture and therapeutic massage, but adhering to a healthy lifestyle is the greatest preventative medicine when it comes to avoiding this painful spinal invader. If you are suffering from a herniated disc, a physical therapist has the knowledge and tools to customize a program that will work for you.

 

You’ve seen them at the grocery store. Perhaps you are one of them. It might be due to old age, bad hips or bum knees, but they’re leaning into their shopping carts. In fact, it seems to be holding them up as they slowly travel up and down the aisles. It is also a recognized sign of someone with spinal stenosis, which is most likely to occur in men and women 50 years of age and older. It is painful and debilitating, and it is almost certain to get worse with time if untreated.

Knee pain may come from within the knee, behind the knee, laterally, in the kneecap and behind the knee, emanating from all kinds of situations and circumstances. Our three-phase knee protocol at Montvale Health Sport + Spine is a thorough way of dealing with a complex joint with so many diagnosable and treatable sources of pain. It all begins with consultation and, from there, a thorough exam by a board-certified physician who has the option of x-raying the joint. This is not a task for the faint of heart or lightly experienced, but as with any issue that throws a wrench into the marvelous machinery of the human body, the diagnosis may be simple or it may require a multidisciplinary team to diagnose and subsequently treat.