The Big Tease

Like a guy who opens his coat and asks, "Hey buddy, wanna buy a watch?", there is no shortage of people who will promise you lots of patients if you will just take their seminar, join their PPO, or become an orthopractor. The pitch is that you can become part of the managed care craze and gain access to the millions of patients who are joining managed care programs.

The reality is that you are losing patients and potential patients as managed care programs replace fee-for-service health care. Health Maintenance Organizations (HMOs) alone care for almost 23 percent of the U.S. population; Preferred Provider Organizations (PPOs) care for another 29.8 percent.¹ A recent survey shows that 63 percent of all privately insured people in the U.S. are covered by managed care plans.

But promises and delivery are two different entities.

The first step is to scare you into believing that you are doomed by the onslaught of managed care. Consider this statement made by Ronald L. Slaughter, MSc, DC, national executive director and chairman of the board of the National Association for Chiropractic Medicine (NACM) and the U.S. division of the Orthopractic Manipulation Society:

"In five years from 50 to 80% of the entire population in the U.S. will be covered for their health needs (regardless of state or federal legislation) by some form of managed care. Workman's (sic) Compensation and a lot of Personal Injury will be rolled into this. Can you survive with only 20-50% of the population having coverage for your services? Worse for chiropractors, HMOs are already providing chiropractic manipulation services 'in-house' for less than 1% of membership fee! Can you compete with that? I said it before and I'll say it again. 'Managed care is here and it is here to stay.' You are either 'in' or 'out.' If you are 'out' -- I don't care WHO or WHAT you are -- you are (economically) dead."

Of course Dr. Slaughter's statement was preceded by the NACM/orthopractic's own offer:

"We are currently exploring several avenues for post-graduate education which will result in a Certificate of Proficiency in Manual Manipulation issued by an accredited, respected, in-house, health care facility. Again, something 'beyond' your current degree -- an educational division, if you will. Why? To market you, of course!"

This echoes statements made earlier by Dr. Slaughter:

"Managed care is here and it is here to stay. Managed care means 'gatekeeper' pure and simple. Gatekeeper means 'orthopractic' practitioner."

But delivery apparently never became reality for Dr. Slaughter's NACM/orthopractic organization. Their numbers went from a purported 1,500 down to probably less than 200 currently. We talked with many of the DCs who became NACM/orthopractic state managers. Most of them never received any patients, became totally disenchanted and resigned. One former state manager (who wished to remain anonymous) remarked:

"I joined this in hopes of getting lots of new patients. This was one big waste of time."

It would obviously be unfair to judge every seminar program or PPO by what has happened with Dr. Slaughter's NACM/orthopractic organization. It is true that many of the managed care organizations which include chiropractors on their provider panels are looking for a method of quickly identifying what many of them refer to as the "good chiropractors."

There are certain organizations within the chiropractic profession that are trying to develop programs to help DCs become better acclimated to the managed care environment. They offer "certification" or "accreditation" in managed care.

There are also several chiropractic PPOs which do have a substantial number of covered lives that will become your patients when you join the provider panel. Some are trying very hard to balance the demands made by managed care with the need for reasonable reimbursement for chiropractic care.

Perhaps now more than ever the maxim, caveat emptor (let the buyer beware) should apply to DCs seeking access and inclusion into managed care. Before you waste your money (and your time), you need to ask the tough questions:

Chiropractic PPOs: How many covered lives in my specific area, divided between how many DCs? What is the rate of chiropractic utilization? What is the average payment per visit/per month? Can I have the names of other DCs who have been in the program for various lengths of time?

Managed Care "Credentialing" Programs: Who recognizes this program? Which managed care organizations require this seminar for membership? How many covered lives do they have in my area? How do they utilize chiropractors? Can I get names of DCs who are already on those panels?

While you may personally know or have talked to some of the NACM/orthopractic refugees, all efforts to assist chiropractic assimilation into managed care should not be so judged. If it is your desire to move into managed care, do so cautiously. A little extra inquiry could be very valuable.

Reference 1. A push in the Pacific. Managed Healthcare, March, 1995.

DMP Jr., BS, HCD(hc)