Chiropractors and Orthopedists frequently jostle each other. The MDs often acknowledge some potential benefit of Chiropractic if used with care. The DCs examine patients who have pain that remains after surgery, and wonder why Chiropractic care was not tried first. Logic would claim that least invasive means should be followed by un-reversible means if possible. But that depends upon the assurance that Chiropractic is safe in these particular cases. This sets the scene for both camps to spread Fear, Uncertainty, and Doubt (FUD). A new study points out that there is plenty of fear—the price tag for the defensive medicine portion of Orthopedic care (the part done to protect the surgeon, not benefit the patient) is just over $2 billion a year.
Surgeries with disappointing outcomes are somewhat common. There is even a series of ICD-9 codes used to describe patients whose back surgeries did not have completely successful outcomes. These codes are properly called Post-Laminectomy Syndrome, although they are sometimes referred to as the “Failed Back Surgery Syndrome” codes. The codes are:
722.80 - Post-laminectomy Syndrome, Unspecified Region
722.81 - Post-laminectomy Syndrome, Cervical Region
722.82 - Post-laminectomy Syndrome, Thoracic Region
722.83 - Post-laminectomy Syndrome, Lumbar Region
737.12 - Kyphosis, postlaminectomy
In the world today, the tie-breaker between surgery and non-surgical treatment is often cost. Chiropractic care is generally far less expensive than surgery. However, the cost of surgery is compounded by the high cost of surgical malpractice.
A recent study, The Prevalence and Costs of Defensive Medicine Among Orthopaedic Surgeons: A National Survey Study, presented in February, 2012 at a convention of the American Academy of Orthopaedic Surgeons (AAOS), determined that “defensive medicine” (defined as medical practices that may exonerate physicians from liability without significant benefit to patients) added significantly to the cost of surgery.
In September, 2010, two thousand orthopedic surgeons were randomly chosen from the AAOS registry and invited to answer a web-based survey on defensive medicine. Sixty-one percent (1,214) completed the survey. Of these physicians, 96% (1,165) reported having practiced defensive medicine by ordering imaging, laboratory tests, specialist referrals or hospital admissions mainly to avoid possible malpractice liability. Nearly a quarter of ordered tests were defensive.
According to the study, percentages used were:
CT scanning, 26%
MR imaging, 31%
laboratory tests, 23%
hospital admissions (defensive) 7%
Using Medicare payment information corresponding to the CPT codes reported, the cost of defensive medicine in orthopedic medicine worked out to be $8,500 monthly, or about $100,000 per year. Using the Department of Labor’s statistic of 20,400 practicing orthopedic surgeons in the United States, this extrapolates the cost of defensive medicine for the specialty of orthopedic surgery to be $173 million per month, or just over $2 billion annually.