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Response to Modern Healthcare’s article, “Rethinking Spine Care”

, March 26, 2014

Vivi-Ann Fischer“Bravo!” to Legacy Health and the other hospital and health systems around the country that are rethinking spinal surgeries, as described in this recent Modern Healthcare article. I whole-heartedly endorse their efforts at improving patient outcomes while reducing unnecessary healthcare costs.

As the Chief Clinical Officer for ChiroCare, and having been a practicing chiropractor for more than two decades, I have witnessed first-hand how the lack of a standardized care pathway for adult low-back pain leaves patients unsure of where to initiate care. The provider selected by the patient influences the diagnosis process and the treatments received. In fact, a 2013 study found that approximately 42.7% of workers with low back pain who first saw a surgeon had surgery, in contrast to only 1.5% of those who first saw a chiropractor.1

We also know based on current research that a lack of standardization in care also leads to inefficiency of care as patients receive unnecessary and costly imaging, increased use of opioids, increased surgeries and device implants. It’s no wonder that the cost of all care for low back pain is estimated to be as high as $86 billion as patients often try several providers to seek pain relief.

To create a standardized point of entry for care and care pathway for adult low back pain, last year ChiroCare teamed with a group of subject matter experts, including primary care providers, neurologists, orthopedic providers, physical therapists, chiropractors, as well as representatives from the Minnesota Community Measurement Project and  participants from the Acute/Sub-Acute Low Back Pain Institute for Clinical Systems Improvement Guidelines team, to form a task force whose goal was to initiate the ChiroCare Spine Centers of Excellence – a highly specialized network of chiropractors adhering to processes and guidelines around assessing, treating and managing low-back pain. The program is designed to:

  • Provide patients with a better experience, including a clearer pathway for care that is more effective and less costly.
  • Improve the collaboration of care among health professionals.

Although it’s in its infancy, we are encouraged that the ChiroCare Spine Centers of Excellence, combined with courageous efforts such as those displayed by Legacy Health and others, will begin to turn the tide of often ineffectual spinal surgeries that are financially burdensome and costly to patients’ quality of life.


  1. Keeney, BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM. Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State Spine (Phila Pa 1976). 2013 May 15;38(11):953-64. doi: 10.1097/BRS.0b013e3182814ed5.