CHIROPRACTIC BEFORE SPINE SURGERY FOR CHRONIC LBP

University Of Pittsburgh Medical Center (UPMC), an HMO affiliated with the school of medicine has adopted landmark guidelines for the management of chronic low back pain. As of January 1, 2012 candidates for spine surgery must receive "prior authorization to determine medical necessity" which includes verification that the patient has tried and failed a 3 month course of conservative management that included physical therapy, chiropractic and medication. This is the first reported implementation of such policy by a health care plan. The health plan informed providers that this clinical initiative will improve the quality of care for members who are considering lower back surgery and that it will facilitate their involvement in the decision-making process. Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level. The UPMC should be congratulated for his leadership and establishing policies to assure that the least invasive and most likely to be successful care strategies including chiropractic care are applied for a meaningful period of time before surgical considerations are made.