Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
The scenario is a very simple one.
The problem is as follows: How to lower the cost of health care
If you are an insurance company or the administrator of a state workers' compensation program, you are under terrific pressure to reduce expenses.
Everyone knows that there is serious waste in healthcare. It has been estimated that the cost of health care fraud and over-utilization in the United States is as much as $7 BILLION DOLLARS PER YEAR! The only question is how to find a way to cut costs.
First of all, you must pick where you are going to look.
Hospitals? --- No, they already have problem.
MDs? --- And attack Marcus Welby? Be serious.
Chiropractors? --- Now there's a possibility.
One problem, those chiropractors tend to be quite popular with their patients.
There have been some indications that they have been over charging. Let's look at this closer.
This is pretty much what took place in Oregon. The State Accident Insurance Fund (SAIF), which administers workers' compensation in Oregon, took one look at the data and knew just how to go about it.
The average payment for a worker's comp care in Oregon is approximately $700. Yet, when you review a list of all Oregon DCs, you find that many practitioners average over $2,000 per case. In addition, some doctors have actually kept over-payments.
This provided a road map for SAIF that even a blind person could follow. But timing is everything. The investigation must be conducted at the most advantageous time. The real task is to get the greatest legislative benefit.
But wait! Chiropractic has one friend -- the patients. Much of the general public feels that chiropractic is of great benefit. Chiropractic also has legislative support.
No problem, the minute the public (patients included) and the legislators learn how chiropractors have been over-charging, most people won't dare try to stick up for them.
So the process began. SAIF chose those chiropractors who either held over-payments, showed very large case averages, or provided them with some other indication. The timing was just before the Oregon legislature was to decide on new workers' compensation laws and the media ate up almost everything SAIF threw at them.
Now the chiropractors of Oregon have seen their workers' compensation privileges go from one of the most liberal, to very restricted. They are, in some respects, very glad they got what they got. At one point in the legislative process, chiropractors were not designated as treating physicians in workers' comp.
The original Oregon Workers' Comp law allowed, when indicated, a patient to receive chiropractic treatment twice every month for life. Now they are restricted to 12 visits or 30 days, whatever comes first.
The process was so easy that it is frightening.
Yes, SAIF went gunning for chiropractic. But the abusers of the chiropractic profession loaded their guns!
Now we have to do what George McAndrews calls "defending the undefendable." We have to resort to the old "every-profession has-its-bad-apples."
But in a profession where abuses are discussed as "1001 Secrets of a Practice Consultant," taught at seminars, listed on posters, and found in chiropractic Yellow Page ads (NOOPE), it is very difficult to make the rest of the world believe there are only a few bad apples.
Some investigation has been conducted about the relationship between workers' comp abuses and the Oregon type of reaction. Each state has a certain number of DCs whose average cost per workers' comp case exceeds the normal "bell" curve. When the percentage of DCs is high enough, the reaction begins. Oregon was over ten percent. A number of other states are at or over this ten percent benchmark.
These states will undoubtedly be next.
So as the profession watches itself get "shot down" in the legislature and publicly, we can thank the abusers. We can thank the "heavy hitters" who are more concerned about short-term wealth than the reputation of the profession.
Until we can satisfactorily demonstrate competence in policing ourselves, the abusers creating these problems will continue to "load the weapons" that kill off the profession.
