Editor's Note: This three-part article series is co-authored by Drs. Dave Elton, John Allenburg, Wayne Bennett, Marty Caron, Darren Chase, Molly Magnani, Ben McDowell, Melissa Naegre, Garret Rock, Robb Russell, and Mike Simone - all doctors of chiropractic. Access their LinkedIn pages for more information at the end of this article Part 1 of this three-part article appeared in the November 2025 issue; part 2 appeared in December.
Imagine an environment in which DCs are tightly integrated with their local healthcare system; a trusted resource for PCPs, specialists and self-insured employers; are reimbursed in alignment with value created; use modern technology enabling them to fully engage with their patients; are self-governed; and are able to maintain a fulfilling work-life balance.
Not only is this possible; it is happening. The co-authors of this series are living and/or building this at scale in markets across the country. In the final part of this three-part series, we explore three areas for chiropractors to focus on to leave the current foolishness behind and create “the best of times” for DCs and their patients.
1. Modernize the Practice Environment
To reach our full potential, DCs must embrace modern technology and take a fresh look at how our practices are organized.
Adopt modern, interoperable EHR technology with open APIs. Hardwiring DCs into the healthcare ecosystem with modern, interoperable EHRs is essential. As one example, secure communication and referrals between providers utilize a global directory, or phone book, of secure direct-messaging addresses assigned by the EHR used. Most DCs are not in the phone book due to their EHR.
Embrace artificial intelligence (AI). AI will automate routine, time-consuming tasks such as note taking, eligibility and benefits verification, visit scheduling, submitting prior authorization (PA) data, appealing PA and claims denials, and working accounts-receivable balances. Using AI to address insurance company and intermediary foolishness frees up staff to focus on what matters: patients.
Centralize administrative services. A modern management services organization (MSO) assembles all elements of the tech stack supporting a practice. An MSO can obtain more favorable pricing than individual practice, reduce overhead, improve operational performance, and insulate a practice from labor volatility, whereby the departure of a key staff person can be disruptive.
Organize for scale and influence. Entities like clinically integrated networks (CIN) allow independent practices to legally come together as a single entity to integrate with and influence the healthcare system.
How is a CIN different from the intermediary PPO networks with which DCs are all too familiar? The primary customer of a CIN is the DC. The primary customer of an intermediary DC network is an insurance company, with the DC being a poorly treated supplier. This distinction between customer and supplier is associated with an entirely different experience for a DC.
Collaborate with primary care providers, specialists and self-insured employers. A geographically distributed group of high-value DCs, organized as a CIN and using a common interoperable electronic health record (EHR), provides an easy button to unlock referrals that are currently hung up in the system.
Lead with real-world outcomes and value, not lower cost. The chiropractic profession must generate maximum impact from limited research capacity. The emphasis needs to be on quantifying real-world outcomes and must be led by, or include significant involvement of, clinicians in full-time practice who know how to make payroll while delivering high-value care.
Create a scalable asset with value. Building a practice on a modern MSO platform and participating in a CIN creates an asset that can be scaled organically, or through mergers or acquisitions. This type of practice has value when the time comes to leave active practice.
2. Advocacy, Legislative, and Regulatory Reform
Straightforward, common-sense policy reforms will enable DCs to operate on a level playing field with their healthcare peers.
Extend MLR consumer protections to entities that receive capitated payments, like intermediary DC networks. Requiring capitated intermediary DC networks to comply with MLR reporting and rebate processes will ensure the intended MLR consumer protections extend to chiropractic patients.
Allow DCs to contract as groups rather than individual NPIs. In addition to being inefficient and prone to errors, individual NPI-level contracting results in DCs being fragmented with limited to no negotiating power.
Allow DCs to review and negotiate individual contracts. DCs being forced to accept take-it-or-leave-it, all-or-none agreements undermines market-based supply-demand contracting dynamics common throughout healthcare.
Ensure that the level of reimbursement does not violate 2706(a) anti-discrimination intent. Capped reimbursement, if very low, can raise anti-discrimination concerns if it effectively eliminates coverage for services provided by a DC that are covered if provided by a specialty without capped reimbursement.
Evaluate the measures, methodology, and statistical validity of intermediary DC network profiling and tiering processes. Invalid profiling measurement processes and procedures are associated with several potential adverse impacts on DCs and should be overhauled or eliminated.
Require adoption of electronic data interchange (EDI) standards. DCs should benefit from the efficiencies associated with the electronic exchange of benefits / eligibility, claims and remittance advice data.
Educational parity whereby student-delivered services are reimbursed if provided under the direct supervision of a licensed DC. Real-world experiences while in training are vital to prepare future DCs for the transition to practice.
Prior authorization (PA) reforms. PA exemption should not be allowed when a patient is financially responsible for >75% of the cost of a visit. The criteria used to approve or deny care, and the administrative burden placed on providers, should be equivalent across all specialties subject to PA.
A DC deciding that treatment is not medically necessary should be required to provide citations supporting the decision and assume malpractice risk in the event of an adverse impact.
3. Legal Remedies
With the passage of the Competitive Health Insurance Reform Act (CHIRA – yes, the acronym is ironic) in 2021, health insurers are no longer shielded by the McCarran–Ferguson antitrust exemption. While CHIRA preserves a narrow safe harbor for specific activities, conduct that previously received immunity no longer does.
Intermediary DC networks, and by extension insurance companies, have been largely unresponsive to years of good faith communication and advocacy. Rising practice expenses, increasing and unnecessary administrative burden, and over two decades of stagnant reimbursement have DCs backed into a corner.
Without alleging illegal or non-compliant activity by any party, DCs are uniquely disadvantaged by the asymmetrical contracting dynamics for participating in insurance company networks that are consolidated in a small number of intermediary DC networks with highly uniform business processes.
Practical Takeaway
The remarkable resilience of DCs to remain viable in a challenging environment is admirable – and exhausting. Grit and determination alone won’t be enough to help the chiropractic profession reach its full potential. More research or new guidelines, though well-intended, will not change the current or future practice environment.
The ability for patients to benefit from access to high-value, nonpharmaceutical musculoskeletal care depends on whether the chiropractic profession can adapt, organize and advocate effectively. Whether you own a clinic, work as an associate or employee, mentor students, engage in reform efforts, or simply refuse to accept the status quo, this moment demands your voice and your action. DCs must evolve strategically, technologically and politically. Every DC has a role to play.
This may well be the most promising time to be a DC. With vision, collaboration, and the courage to act, we can align evidence, opportunity, and professional fulfillment, and step into the future chiropractic has long deserved.
Let’s make it the best of times.
Access the co-authors’ LinkedIn pages below:
