Inside this Issue
UPMC VS. HIGHMARK
Office Hour Changes
Back Surgery: Too Many, Too Costly and Too Ineffective
(Title and source from To Your Health magazine, June 2011)
I just read a magazine article by the title above and found it very interesting. It focused on research on back surgeries from the 1990s through 2010. You may find some of it as interesting as I did. Being a person who has experienced a serious episode of back pain and continues to work to keep my own back strong, I can identify with many of you who come to the office for relief and to keep your backs in their best condition.
Too Many, Too Costly
Statistically, 80% to 85% of Americans suffer back pain at some point in their lifetimes.
Consider these numbers on back pain:
- 500,000 disc surgeries annually
- Only 10% are successful in fully relieving back pain
- There was a 15-fold increase in back surgeries over a recent six-year period
- Back surgery in the U.S. is done 40% more often than in any other country; five times more often than in England
- Back pain ranks #8 on the Top 10 List of diseases in America
- The average spine surgery case averages $18,000 to $35,000. When all costs such as MRIs, meds, Physical Therapy and disability are considered, the total cost ranges from $100,000 to $169,000
Consider the results of a 2010 study of 1,450 Ohio Workers’ Compensation patients--all of them had similar diagnoses of disc herniation, sciatica, or disc degeneration. Researchers compared those who had surgery versus those who chose not to. Here is what they found:
- After 2 years, only 26% of the surgery patients returned to work, compared to 67% of those who did not have surgery
- Of lumbar fusion patients, 36% had complications and 27% required a second operation
- 11% of the surgical patients were permanently disabled versus 2% of the nonsurgical patients
- 76% of patients continued using strong opioid drugs even after their surgeries
These findings led to a researcher at the University of Cincinnati College of Medicine to conclude that, at least in a workers’ compensation setting, these surgeries are “associated with a significant increase in disabilities, medication use, prolonged work loss, and poor return-to-work status.”
The newsletter editors of the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C. said: “Despite a steady stream of technological innovations over the past 15 years-from pedical screws to fusion cages to artificial discs-there is little evidence that patient outcomes have improved.”
Chiropractic: First Choice for Back Pain
Chiropractic may be the single best choice for many people suffering from back pain. Anthony Rosner, Ph.D., testifying before the National Institute of Medicine, stated: “ Today we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option. ”
Military personnel gave their highest rating to chiropractic care for back pain, at least 10% higher than any other health care option.
The government Agency for Health Care Policy and Research came to these conclusions after studying and comparing the various treatment options for back pain:
- “Spinal manipulation offers both pain relief and functional improvement.”
- “For acute low back pain not caused by fracture, tumor, infection…spinal manipulation is the treatment of choice.”
The Bottom Line
Back pain can be a frustrating, disabling condition, especially when it is chronic or recurrent. Because of scar tissue, joint and disc degeneration over time, repetitive work and home physical stresses and strains, back pain management may be a long-term problem for many people.
Surgery is rarely the best option for care. Considering its high cost and low success rate, it should be a measure of last resort.
Numerous American and international research studies have proven chiropractic care to be a highly effective, conservative treatment for low back pain, very possibly the best.
Food for Thought
I apologize for the technical nature of this newsletter article. Very little is from me; most are direct quotes from the article referenced. I had to rewrite a research paper on chiropractic in my undergraduate English class. The professor said I plagiarized because too much of it was quotes. I may have repeated that here!
But I believe the information is worth sharing and hopefully will give you food for thought should you find yourself trying to decide how best to manage your own back’s health.
Highmark Blue Cross/Blue Shield Battles Against UPMC’s Attempts to Monopolize Western PA’s Healthcare Choices
Several of you have asked me recently about the fight between Highmark and UPMC. Their duel is making the news regularly. The outcome of this battle affects all of us in Western PA and so I will try to explain the situation the best I can as I see it .
What’s Going On?
You probably have noticed over the past decade how UPMC has taken over many of our region’s hospitals and continues to go after those attempting to remain independent. Apparently, their plan has been/is to create a monopoly of the healthcare system to enable them to force health insurers and doctors to accept their demands for reimbursement.
In recent months, UPMC has demanded a 40% increase in payments from Highmark for its members to utilize UPMC facilities and doctors. Highmark refused, of course. So UPMC is now trying to scare BC/BS members into believing that they will no longer have access to UPMC health system assets.
- · Despite their threats, UPMC is under contract with Highmark BCBS through June 30, 2013. It would be illegal for them to carry out such actions before then.
- · Some UPMC facilities are not wholly owned by UPMC and are sustained by taxpayer money, tax breaks, state and federal grants. Examples of such include Magee Women's Hospital, the Hillman Cancer Center and Western Psychiatric Institute. The public has rights, therefore, in what goes on concerning these.
- · Highmark is countering UPMC's monopoly efforts by stepping in to support the West Penn/Allegheny Hospital System. This includes Forbes Regional Hospital in Monroeville. They have been struggling to survivie against UPMC. Highmark's help would insure we have choices in healthcare and guards against increased costes if UPMC gets full control.
- · UPMC health plans limit your choices of doctors. It is especially difficult for chiropractors to join. I have been unable to get into the UPMC network for years now. My chiropractor friends who are in network, however, feel UPMC is unfair to them and their patients.
I appreciate how many of you choose our office despite me being out of network for UPMC. We will continue making efforts to join so that you may receive greater benefits from the UPMC premiums you pay.
How a Complete UMPC Monopoly Could Affect Us
- · Higher premiums and out of pocket costs
- · Limited choices of doctors and hospitals
- · Greater distances to travel to receive healthcare services
- · Potentially lower quality of care due to lack of competition and demoralization of overworked UPMC healthcare providers
- · If you get health insurance from your employer, ask them if they offer a Highmark BCBS plan as a choice.
- · If you have UPMC insurance, call customer service and tell them you may switch plans if they fail to negotiate a new contract with Highmark.
- · While you are at it, tell them you are unhappy with them limiting your choice of chiropractors and request that they add me to their network!
- · Contact your local state representatives and tell them you are concerned about UPMC's efforts at monopolizing healthcare in our region. Some people have said that UPMC's actions may violate some rules, but officials are hesitant to act because UPMC is one of the largest employers in our area.
- · If you work for UPMC, do your best for them, as always. Please don't complain to them based on what you have read here. I don't want anyone losing their jobs!
This is my best and honest understanding of what is going on between UPMC and Highmark. Though I have no great love for insurance providers, whether private or our government, my experience with Highmark BC/BS as a network doctor has been largely positive. They appear to have some glitches in their chiropractic coverage. However, their PPO plans, in my experience, are the best health insurance plans out there right now.
Since I am not bound to UPMC, I have tried to respond to the questions asked me in the office in a frank and straightforward manner. Hopefully, it may help ease your concerns and confusion about what you read and hear in the news.
New Medisoft System
Our office is in the process of updating our current billing system. Our hope in the end is to have a better and simpler bill being sent to you. Unfortunately, before that can happen, we have to integrate our old and new systems. During this transition, you may receive two bills. One bill will be for any transactions prior to April 1, 2011 and the second bill will be for transactions occurring after April 1, 2011 . We apologize for any inconvenience that this might cause you, and appreciate your patience during this transition. If you have any questions, please do not hesitate to call our office. We will gladly assist you in clarifying any issues that arise.
Gift Certificates Available
Looking to give the gift of chiropractic to someone you love? We have Gift Certificates available for purchase in any denomination. See Colleen or Julie at the front desk for more details.
Upcoming Dates of Office Hour Changes
Monday, August 15th – OFFICE CLOSED
Wednesday, August 17th – OFFICE CLOSED
Thursday, August 18th – OFFICE CLOSED
(Dr. Wohar will be taking Stephanie and Joseph to college on these days)
Friday, August 19th – Office Hours: 10am-5pm