A Republican state lawmaker is offering a narrowly crafted plan he thinks will help ease the opioid crisis and save to state millions of dollars.
The proposal from Representative John Wiemann of O’Fallon would allow chiropractic physicians to treat Medicaid recipients for back pain. A House committee unanimously passed the measure by a 10-0 margin Tuesday.
Currently, people served by the low-income federal health program are required to seek care for such ailments through traditional medical doctors.
Wiemann says there’s misplaced concern among various provider groups that this legislation would expand the scope of what chiropractors are allowed to do in general.
“They’re licensed to do certain things by the state of Missouri, spinal manipulation and those things,” said Wiemann. “They have to practice within their scope of practice what they’re licensed to do. And that’s all. This is simply to say they’re going to be allowed to practice within their scope of practice for the Medicaid population.”
At least 26 states currently offer some form of Medicaid chiropractic benefit under a fee for service arrangement.
Research from the University of North Carolina School of Medicine has shown that more than 80 percent of Americans will experience an episode of low back pain at some time in their lives, with the total costs of the condition estimated at greater than $100 billion annually. Most of the loss is blamed on decreased wages and productivity.
In 2017, the American College of Physicians (ACP) released new guidelines for managing lower back pain. The guidelines advised non-drug options first—including spinal manipulation performed by chiropractors.
Representative Wiemann contends that offering chiropractic care for Medicaid recipients would reduce potential opioid addiction, and save the state money by reducing visits to more expensive providers and emergency rooms.
“It’s proven through the research that if we can direct people to less invasive procedures, and get them to, at least do that first before they look at going to more invasive type treatment plan, that we can save that person a lot of pain and suffering, and ultimately save the state of Missouri money,” Wiemann said.
This year the Joint Commission, a U.S. based nonprofit that accredits health care organizations and programs, is requiring hospitals to offer non-pharmacological treatment options that include the services offered by chiropractic physicians.
Representative Wiemann’s office released a statement in December, saying studies suggest integrated care from chiropractic physicians could decrease the number of opioid prescriptions by up to 77 percent in patients suffering from chronic pain, and save the state between $12.9 million and $21 million a year.
His proposal, known as House Bill 1516, is one of 12 pieces of legislation being considered by the chamber’s Insurance Policy Committee. Wiemann, who is the Vice-Chairman of that committee, sponsored the same measure last year. It passed in the House by a bipartisan 136-11 margin before it failed to gain traction in the Senate.
Governor Greitens has called for roughly $8.3 billion of the state’s total budget of $28.75 billion to be directed to Medicaid. Republican lawmakers often complain about the cost increases to Medicaid, which will rise by close to $340 million this year. Wiemann says his proposal would have no financial impact on the federal health program.
“The nice thing about this is that we’re not doing any new funding for Medicaid,” said Wiemann. “This is simply saying chiropractors can now offer services which are not new services. These are services that are currently allowed under Medicaid. It’s just that chiropractors have been excluded as far as being providers within the Medicaid program.”
A financial statement prepared by the nonpartisan Legislative Research Oversight Division says the net effect on the state’s general revenues would be less than $3,284,707 in the upcoming fiscal year.
The statement also said “MO HealthNet (Medicaid in Missouri) may see savings by including chiropractic physicians as a provider group. MO HealthNet is currently reviewing data on potential cost savings and will provide the estimate once it is available.”
Representative Wiemann is not a medical doctor or a chiropractor but is heavily involved in the industry through his business as the owner of an insurance brokerage firm.
He has a master’s degree in healthcare administration and says he’s worked for hospitals, physicians and insurance companies in the past. His parents operate a home for developmentally disabled individuals that they’ve owned for 40 years.