Ongoing changes in the health care arena have and continue to present health care management with new challenges and problems. Added to the complexity of care required by many patients are factors such as payer constraints and the increased need for patient education in low cost effective care. As managed care organizations merge, health care providers cannot always address the needs of patients. To meet these new challenges, the chiropractic profession needs leadership which is able to meet with health care organizations, insurance companies and managed care organizations.
If chiropractic is an essential health profession, it needs to demonstrate this, not only by meaningful research, but by dedicating all our attention on the patient. Our colleges must emphasize the fact that chiropractic care is patient centered and that we are eminently qualified to triage patients when necessary. No, we are not a component centered profession like allopathy which emphasizes disease and the millions of expensive high tech tests which add unneeded costs to patient care. Do you think industry knows these facts? I for one doubt industry can spell "chiropractic," unless it is in a derogatory sense in which a "rip-off" by a DC is cited as evidence of why the entire profession cannot be trusted. While this form of bias is rampant, we seem to be in denial. Either our leadership agrees that chiropractic needs to be tightly controlled and will accept an MD gatekeeper, or we refuse to admit that a small number of DCs are utilization abusers. In both cases, we will do anything to "belong." Instead, we need leaders in every state, as well as national leaders, who are capable of solving everyday problems, whether small or large, if they adversely and unfairly affect the patient.
The Problem
Health reform has handed over the treatment of patients to businessmen who are interested in the bottom line first and too often, last as well. There are exceptions to this, but they are few! As MCOs merge, this will become a greater problem.
The Victim
As I see today's health care, the patient is the victim. Patients are told what benefits they will receive, how much they will be reimbursed, but are denied choice of chiropractic care in more than 50 percent of the packages.
Controllable Variables
Some variables are controllable. If the profession educates the MCOs, insurance companies, government and the press on the qualifications of the modern chiropractic physician, coupled with our dedication to evidence based health care which centers exclusively on what is best for the patient, we will go a giant step toward our public mission.
Uncontrollable Variables
Some variables are beyond the immediate influence of any profession: these are the attitudes of the payer community as they conceive their responsibilities to the public. These attitudes derive from a deep sense of business ethics or severe lack thereof. Ultimately, these become constraints which may be equitable or unfair against chiropractic care.
Most problems have more than one solution, and while some solutions are better than others, the ultimate test of any solution is patient satisfaction. Why? Because the outcome of any health care is from the patient's perspective, not any profession's point of view. Let's face it, professions have become self serving. To have outcomes only certified by health providers, is to put patients in a position of subservience: a nice name for bondage. You know, "the doctor knows best." Of course medical public relations experts will tell you that MDs are victims of avaricious lawyers. However, too numerous are the studies which reflect this scenario.
Constraints
The typical constraints practicing chiropractic physician encounters are:
- time allowed for treatment;
- costs of treatment;
- procedure choices;
- benefit exclusions -- little or no access to chiropractic care;
- provider restrictions -- view that no DCs are needed.
This profession cannot revert to its "ghetto mentality," as George McAndrews refers to it, wherein DCs think ourselves inferior to the MD; wherein we think our education is inferior, and that medical treatment is pure science, based exclusively on outcomes from randomized clinical trials. Today our profession's future demands creative thinking; thinking which is productive for increased acceptance of chiropractic in all forums.
Steps in Creative Thinking
- Focus exclusively on the constrains which act as barriers to chiropractic choice by the public.
- What do we want to accomplish? In what arenas must we offer solutions. Obviously legislation is most important, but is by no means the only avenue to address.
- Who and what are preventing our desired accomplishments? Don't blame our problems only on MDs, insurance companies etc. A penetrating look at ourselves is mandatory. We have two or more of national associations, state associations, and so on. Thank God we have one accrediting body for chiropractic education, and we tried damn hard to have two, did we not?
- Develop feasible solutions. We must evaluate all constraints against chiropractic. This necessitates scholars in economics, ethics, law, business and government being retained to help us solve the constraints that all ethical competent practicing DCs know exist.
The feasible solutions for chiropractic must be judged not by academicians, researchers or political pundits, but by the ability of citizens to develop into chiropractic patients all across America. If we judge solutions based on the narrow views of segments of our profession, we will lose our future.
In my view, chiropractic needs to awaken to the great potential which exists for serving mankind. We need to understand that all constraints will not be solved by a single plan. We long ago eschewed the monocausal theory of disease, so let's not believe a single solution, whatever it is research, education, politics or PR, will remove the market constraints on chiropractic.
We need all segments of chiropractic if we are to be problem- solvers. How do you feel?
Arnold Cianciulli, DC
Bayonne, New Jersey
