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Jeff Van Ness, (202) 955-3518

Back pain, second most common symptom-related reason for doctor’s office visit, accounts for 25 percent of workers’ compensation claims; plans, employers express interest in program

WASHINGTON—More than 100 physicians and chiropractors nationwide [see attached list] have committed to be evaluated under the Back Pain Recognition Program (BPRP), a new program developed by the National Committee for Quality Assurance (NCQA) that recognizes health care providers who deliver top-quality care to patients with low back pain.
Back pain is among the most common ailments in America. Each year, nearly 1 in 9 Americans experience pain severe enough to impair their usual daily activities. Treatment costs total approximately $91 billion a year and accounts for 25 percent of all workers’ compensation claims. The BPRP is the first independent effort to systematically evaluate back pain care.

“’Do no harm’ is a bedrock principle of medicine. But needless tests and procedures that provide no real benefit to the patient can’t do anything but harm,” said NCQA President Margaret E. O’Kane. “This unprecedented response by caregivers indicates a strong desire for guidance on what represents top-quality care.”

During the first six weeks of a back pain episode, ample evidence shows that physicians should advise most patients to resume normal activity within a few days. Extended bed rest was found to have no benefit for most patients with back pain. Absent other clinical indications, doctors and patients should also avoid unnecessary x-rays and other imaging services during this initial period of care. Yet studies have found that as many as 4 in 10 imaging studies associated with low back pain are unnecessary and up to 2 in 3 epidural steroid injections are avoidable—with no significant differences in health care outcomes as a result. NCQA’s back pain program aims to reduce the overuse of these services. A new actuarial analysis performed by Towers Perrin found that strict adherence to NCQA’s evidence-based guidelines on these two dimensions of back pain care alone could result in savings of at least $205 per patient per year in direct medical expenses.

The tremendous variation in back pain treatment, coupled with its high cost, is an area of great concern among employers. “It may be counterintuitive on the surface, but good health care usually costs less,” said Francois de Brantes, National Coordinator of the Bridges to Excellence program, a coalition of employers, physicians, health care systems and others dedicated to recognizing and rewarding health care providers. “The benefits of consistent care for back pain go beyond medical cost savings—it includes recovered sick days and healthier, more productive workers. That’s why we’re proud to support the BPRP.”  Bridges to Excellence plans to announce a new initiative utilizing the NCQA program in the near future.

Many health plans intend to assist providers that come forward to participate in the BPRP through data collection assistance, direct financial incentives, notation of their recognition in provider directories or placement in high-performance networks. “The compelling factor in care for back pain is comparing one course of treatment to another and asking which provides the best outcomes for the patient with the least invasiveness or potential for harm,” said Donald Storey, M.D., Senior Medical Director, Aetna Performance Networks. “The BPRP provides a foundation for asking these questions, and represents a tremendous opportunity for supporting our network physicians who provide care for back pain. We applaud the new standards.”

Physicians welcomed the new standards. “Solid, evidence-based guidelines are the cornerstone of quality improvement efforts,” said William C. Watters III, M.D., Bone & Joint Clinic of Houston, Clinical Associate Professor at Baylor College of Medicine and chair of the Guidelines Oversight Committee of the American Academy of Orthopaedic Surgeons. “The treatment guidelines set forth in the BPRP are a promising platform upon which health care providers of every stripe can build their efforts to improve the care they deliver to their patients with back pain.”

For more information about the BPRP, including complete application materials and the BPRP data collection tool for physicians wishing to apply for the program, visit NCQA’s Web site at

NCQA is a private, non-profit organization dedicated to improving health care quality.  NCQA is the nation’s leading developer of health care evaluation tools, including health plan accreditation, physician recognition and organization certification. NCQA also is responsible for the evolution of HEDIS®, the nation’s most widely used set of health care performance measures. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health choices. For more information, visit

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Advanced Pain Management (Greenfield, Wis.)
Bloomington Family Chiropractic, PA  (Bloomington, Minn.)—Cory Emberland, DC.
Bone and Joint Clinic of Houston—William C. Watters III, MD; Sherwin J. Siff, MD; William M. Granberry, MD; Todd E. Siff, MD; Thomas D. Greider, MD; Marc R. Labbe, MD; Taylor D. Brown, MD; Roy B. Smith, MD; Walter R. Sassard, MD.
California Pacific Medical Group (San Francisco)—Bruce McCormack, MD; Brian T. Andrews, MD; Charles S. Cobb, MD; Peter B. Weber, MD; Thomas A. McClure, MD; Christopher Cody, MD.
Carle Spine Institute (Urbana, Ill.)—Victoria Johnson, MD; Aiping Smith, MD; Robert Hurford, MD; James Harms, MD; Charles Wright, MD; William Olivero, MD; Zeeshan Ahmad, MD.
Center for Functional Assessment Research (Amherst, N.Y.)—Carl V. Granger, MD.
Dziura Chiropractic Center (Branford, Conn.)—David B. Dziura, DC.
Eastern Shore Chiropractic Associates, PC (Plymouth, Mass.)—Gregory V. Mara, DC; Ian C. Paskowski, DC.
Fogg Chiropractic (Fortuna, Calif.)—Andrew Fogg, DC.
Georgia Spine & Neurosurgery Center (Decatur, Ga.)—Kaveh Khajavi, MD.
Grieves Chiropractic Pain Relief Clinic (Shawano, Wis.)—Brian Grieves, DC, MPH.
The Henry Ford Medical Group (Detroit)—Marilyn L.G. Gates, MD; Jack Rock, MD; Donald Seyfried, MD; Muwaffak Abdulhak, MD; Asim Mahmood, MD; Stephen Bartol, MD; Kost Elisevich, MD; Max Kole, MD; Nuala Crotty, MD; Norm Rotter, MD; Andrew Biondo, MD; Shlomo Mandel, MD; Mokel Chedid, MD.
Hug Chiropractic Clinic (Birmingham, Ala.)—Brad Russell, DC.
L.A. Sports and Spine (Los Angeles)—Craig Liebenson, DC.
Mayfield Clinic & Spine Institute (Cincinnati)
New England Orthopedic Surgeons (Springfield, Mass.)—R. Scott Cowan, MD.
Quatro Chiropractic (Webster, N.Y.)—E. Daniel Quatro, DC.
Rhode Island Spine Center (Pawtucket, R.I.)—Donald R. Murphy, DC.
Rochester Chiropractic Group (Rochester, N.Y.)—John M. Ventura, DC; Brian D. Justice, DC; William DeSandis, DC; Jeremy S. Lee, DC; Eric Perlman, DC.
Signature Health Services (St. Louis)—George Schoedinger III, MD; Frank Petkovich, MD; Thomas Lee, MD; R. Peter Mirkin, MD; Ravindra Shitut, MD; Lukasz Curylo, MD.
Sligh Clinic of Chiropractic (Lakeland, Fla.)—Stephen E. Sligh, DC; David W. Choate, DC; Christopher L. Terry, DC.
Spine and Pain Care Center (Pittsburgh)—William Tellin, DC; Michael Schneider, DC; Frank Imbarlina, DC.
The Spine Center at Dartmouth Hitchcock Medical Center (Lebanon, N.H.)—12 physicians.
Sport and Spine Rehab (6 locations in Md., Va.)—Jay Greenstein, DC; Sarah Day, DC; Riccardo Tersigni, DC; Venessa Bartholomew, DC; Paul Abosh, DC; Joseph DelRosso, DC; Christopher Steacy, DC; Martin Donnelly, DC; Allen Huffman, DC.
Texas Back Institute Physicians, P.A. (Plano, Texas)—20 physicians.
Total Health Chiropractic and Rehabilitation Clinic (Memphis, Tenn.)—Kenneth P. Clenin, DC, CCRD, CSCS; Allison Bomar, DC.
Vanderbilt University Spine Center (Nashville, Tenn.)—Dan Spengler, MD; Rick Davis, MD.
Wake Forest University School of Medicine (Winston-Salem, N.C.)—Charles L. Branch, Jr., MD.