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Chiropractic Claims Pain California Employers

August 17, 2003|Marla Dickerson | Times Staff Writer

Nearly everyone has an opinion about what ails California's workers' compensation system. Safeway Inc. is particularly sore about its chiropractic bills.

After a fall or strain, the grocer's California workers visit their chiropractors an average of 40 times -- about four times as often as the company's employees in neighboring Oregon and Arizona.

That's a big reason why the chain's average cost per claim in California dwarfs that of the other 19 states in which it operates, said William Zachry, vice president in charge of workers' compensation for the Pleasanton, Calif.-based company.

"We have the same checkers and meat cutters and bakers in California as we do everywhere else in the country," said Zachry, whose company is self-insured and employs 73,000 workers in the state. "The jobs are the same. The injuries are the same. But the workers in California are utilizing much more treatment .... It just doesn't add up."

One employee, he said, has had more than 400 chiropractic treatments since 1999, and several others have exceeded 300 visits. "We're simply unable to stop it," he said.

Chiropractic care is one of the costliest and fastest-growing components of California's workers' compensation system, part of an explosion in medical costs that has thrown the employer-paid insurance program into turmoil.

Last year, insurer payments to chiropractors totaled $235 million, nearly double the level of five years earlier, according to the Workers' Compensation Insurance Rating Bureau of California, which compiles data on workplace injury claims. Chiropractors now command a bigger share of workers' compensation dollars than any other medical specialty, generating more fees than even general practitioner physicians.

One reason injured California workers are visiting their chiropractors so often: Because they can.

In contrast to other states that have capped chiropractic visits or require a gatekeeper to approve usage, California has no limits on the frequency or duration of treatment. It's also one of the few states that allow chiropractors to be an injured worker's primary treating physician.

The result is that injured California workers who seek chiropractic treatment average 34 visits to their practitioners -- double the average in other large states, according to the insurance industry-funded Workers Compensation Research Institute in Cambridge, Mass.

"The whole system is designed to stretch out treatment for as long as possible," said John Haecker, former workers' compensation manager for Monterey Mushrooms Inc., a grower in Watsonville that has been battling rising costs. "The incentives are completely backward."

Supporters of California's nearly 15,000 licensed chiropractors say it's money well-spent to have patients avoid addictive drugs, expensive surgery and other invasive medical procedures. Studies have shown that chiropractic treatment, in which practitioners manipulate the spine to eliminate subluxations, or misaligned vertebrae, can be a highly effective and economical tool to treat bad backs and related injuries.

"Patients typically choose chiropractic after they've tried everything else. But they stay with it because it works," said Wayne Whalen, a spokesman for the California Chiropractic Assn.

Equipment operator Douglas Dover credits his twice-monthly chiropractic visits with keeping him on the job and off the operating table after he wrenched his neck 15 years ago. The Tracy, Calif., resident said the 20-minute sessions provide the only effective relief from persistent tingling in his thumbs and stiffness in his neck.

"I don't think I'd still be on a backhoe without it," said the 50-year-old utility company laborer, whose hundreds of visits have been fully paid by his employer. "It has kept me working. It's good medicine."

But whether it's good economics is a subject of hot debate in California. Heavy use of chiropractic services has yet to result in overall savings in a system in which back injuries are the No. 1 source of claims.

Employers and insurers complain that its potential benefits are being lost amid excessive treatment, propelled by practitioners who are milking the one cash cow left to them in an era of managed care, as well as by workers content to let their bosses pick up the tab for chiropractic "maintenance" that can last for years. Fraud is hard to prove and expensive to prosecute, leaving many employers with little choice but to pay claims they suspect are inflated.

Some lawmakers are trying to limit chiropractic services for injured workers. Sen. Jackie Speier (D-Hillsborough), for example, has proposed legislation that would require an independent medical review panel, insurance company or self-insured employer to approve anything beyond 15 visits for each work-related injury.

Chiropractic fans say such restrictions would shortchange workers while punishing honest practitioners for the actions of a few cheats. But Speier and others say tough oversight is needed.

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