A Look at the Future

A remarkable debate developed at a practice enhancement seminar that I attended recently. The future direction of the chiropractic profession was discussed, and the actual survival of the profession was seriously questioned by several participants. The audience consisted of many high-level practitioners holding postgraduate certificates and earning gross incomes up to one million dollars or more.

The consensus of this audience may be summarized as follows:

1. The health care crisis in this country will become more serious than most of us anticipate.

    

2. Many chiropractors have been adversely affected, but that a much greater and widespread impact will occur.

    

3. This era in chiropractic may be characterized as repressive times (despite the superficial gains that we have accomplished) which may lull us into comfortable complacency.

    

4. Organized medicine is continuing to position itself as the sole health care voice in this country. The stage is being set in which chiropractic can be diminished to an important faction in the future.

a) Medical doctors and physical therapists (even as primary care) are manipulating more patients in an arena of good insurance reimbursement. Patients are gravitating to these practitioners who are insurance-reimbursable and moving away from chiropractors, whose insurance reimbursement is deteriorating.

b) Spinal manipulation is being accepted by organized medicine and viewed as a lucrative profit-center to supplant their declining hospital-based income.

5. Insurance companies and utilization review firms are rejecting a massive amount of chiropractic claims based on lack of medical necessity (for which no standard definition exists, but is being defined to allow unilateral, unqualified rejection of routine, needed chiropractic services).

a) Unique rejection of chiropractic claims by other cunning methods is occurring even in insurance-equality states, these laws are being circumvented by disallowing "manipulation of the spine" while boastfully covering chiropractic services.

b) Chiropractic costs are being rejected by insurance companies for treatment of non-spine related disorders and performance of lab procedures.

6. Our major chiropractic organizations are not in touch with reality about the above discrimination and containment efforts experienced in busy clinical practices. A chiropractic practice grossing one-half to one million dollars yearly will encounter much more containment effort much earlier than smaller practices or than association officers will see.

7. In most cases, chiropractors function as individuals bent on their own survival. There is little foresightedness and little organizational loyalty, which is fueled by weak leadership.

My intention in providing these observations is to stimulate associations in understanding practitioner concerns which it may not have had the opportunity to experience.

A secondary intention is to stimulate more ethical chiropractic practice and to cause a rally of chiropractors to support their chiropractic associations and organizations.

Gerald Andreoli, D.C., FICC
Arlington Heights, Illinois