The Future of Fee-for-Service
As health care moves inexorably towards managed care, many DCs are questioning if they will be able to practice as they do now. MDs are asking many of the same questions.
The American Medical Association (AMA) published a series called the "Doctors Resource Service," designed for MDs who are concerned about the coming changes, particularly managed care. A recent bonus issue addressed "The Future of Fee-for-Service Medicine Under the Clinton Proposal."
Written by two attorneys, this document considers the changes that could befall fee-for-service given certain assumptions. The important points of the paper are presented in its final paragraph:
"In summary, fee-for-service medicine can remain a viable practice option for many physicians -- but only if they are able to price their services competitively with capitated plans. Thus, the future of fee-for-service will inevitably involve significant controls both on the utilization and fee levels. The ultimate challenge for fee-for-service practitioners will be to structure these controls in a manner that permits the delivery of high-quality medical care in an efficient manner."This may hold some wisdom for DCs as well.
"A (medical) specialist position would have to be eliminated every 20 minutes from now until the turn of the century to keep physician supply in balance with demand."
The quote comes from the article, "Market Changes Hasten Oversupply of Physicians" in the August 8, 1994 issue of the American Medical News. Even an optomistic view estimates an excess of 138,000 specialists and 24,000 primary care medical doctors. These forecasts suggest strong competition leading to more salaried positions, fewer large fee-for-service practices, underemployment and a general reduction in income.
The authority for these predictions is Jonathan P. Weiner, PhD, associate professor of health policy and management at the John Hopkins School of Public Health. Dr. Weiner predicts that between 40-65 percent of Americans will be treated from "integrated managed-care networks" by the turn of the century.
As a point of reference, there is currently one MD for every 425 people. Dr. Weiner estimates that by the year 2000, there will be one for every 700.
Many of these same issues relate to the chiropractic profession. There is no doubt that managed care is having an effect on all health care providers.
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
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