Systems and Policies

Chiropractic care availability and financial coverage policies are barriers to care that, if addressed, can enhance implementation.

Barriers

Regulatory restrictions in covered services and scope of chiropractic care by third-party payors

There are many examples where limited insurance coverage hinders access to chiropractic care for patients. Additionally, there are limitations in Medicare policy on reimbursement for chiropractic services to partial scope. Chiropractors are only reimbursed for three Current Procedural Terminology codes related to manual manipulation of the spine, with federal legislation actively proposed to amend this restriction. Policies incorporating scope restrictions (e.g., limited billable services) or requiring prior authorizations or referrals may lead to a decreased ability to provide comprehensive chiropractic care and limit its effectiveness.

Limited access to chiropractic care due to geographical location

The shortage of healthcare professionals available to serve rural communities includes those providing chiropractic services. This can limit access to chiropractic care for patients living in these geographic locations.

Facilitators

Policy that supports reimbursement of chiropractic services at the full scope of practice of the provider for all people who may seek care

Policies that ensure comprehensive reimbursement for chiropractic services, covering the full scope of a chiropractor's practice, significantly enhance patient access to care. Adequate reimbursement reduces out-of-pocket expenses, making chiropractic care more affordable and encouraging its use. Examples like expanded Medicaid coverage or programs like the Oregon Back Pain Program have demonstrated how targeted policies can improve access for specific populations, ensuring that more people can benefit from chiropractic care without financial barriers.

Policies and delivery networks that make chiropractic care accessible to more people with musculoskeletal pain for whom the care may be effective

Policies and robust delivery networks that improve access to chiropractic care for individuals with musculoskeletal pain, particularly those for whom it is effective, are crucial for broader use. Access models that permit patients to seek chiropractic care directly without needing referrals or prior authorizations streamline the access process and empower patients to seek chiropractic care directly.

The number of chiropractors available in a geographic region influences service use, including reduced prescription of opioids

More chiropractors in a given area can improve the accessibility of the service and has been linked to reduced opioid prescribing, suggesting that increased access to chiropractic care may offer a valuable alternative for pain management.