Calif. W.C. Treatment Bill Would Limit Chiros

S.B. 354, authored by Senator Jackie Speier, D-San Francisco, would require injured workers to obtain a doctor's referral for more than 15 visits to a chiropractor under the workers' compensation system.

"This bill is important because medical costs are out of control," said Nicole Mahrt, director of public affairs for the American Insurance Association in Sacramento, Calif.

"If steps are not taken to reduce costs, the system will be unaffordable to many businesses. Private insurers, self-insured companies and the State Fund are all struggling with the same problem: skyrocketing medical costs," said Ms. Mahrt.

Currently, Ms. Mahrt said, there are no limitations to the number of visits an injured worker can make to a chiropractor.

"Other states with high medical costs have implemented caps on chiropractic care and found their costs were reduced," she explained. "This bill does not limit chiropractic care, it just says if you want more than 15 one-hour visits, you should get a referral from a physician."

She added that most other specialists require a physician's referral, including physical therapists.

Other states that have set limits on chiropractic visits to bring medical costs under control include Alaska, Arizona, Florida, Hawaii, Kansas, North Carolina and Washington, according to the AIA.

Studies by the California Workers' Compensation Institute and the Workers' Compensation Research Institute indicate that chiropractic care is an increasingly expensive and over-utilized form of treatment for industrial injuries in California, the AIA said.

"CWCI found that workers' compensation insurer payments to chiropractors rose 153 percent from $77 million to $195 million in just five years," said Mark Sektnan, AIA assistant vice president, Western region, in a statement.

He added that a study by WCRI uncovered that costs for chiropractic-directed care are 30 percent higher than physician-directed care for nonsurgical back problems and that chiropractic utilization is much higher in California than other states.

S.B. 354 is similar to a system adopted in Oregon, the AIA said. During the 1980s, Oregon's workers' comp system ranked among the most expensive in the country, while providing some of the lowest benefits to injured workers.

In 1990, Oregon adopted legislation to limit the number of chiropractic visits to 30 days or 12 visits without further authorization by a doctor, according to the AIA.

Prior to implementation of these controls, chiropractic care accounted for 16 percent of medical treatment costs. By 2000, the Oregon Department of Consumer and Business Services reported that costs for chiropractic care had dropped to 2.6 percent of medical treatment costs, resulting in savings of nearly $26 million, the AIA said.