Over the past several years, the chiropractic media has published numerous articles discussing Medicare reviews of the care delivered in chiropractic offices. Care that is delivered for maintenance or wellness purposes is, by definition, not reimbursable under most third-party-payer contracts. However, most chiropractic practices are riddled with senior patients who opine that they continue to live and function independently, partly due to the care they receive at the hands of their chiropractor. Therefore, should not such maintenance care be covered?
While ongoing medical care, ranging from prescription hypertension medications for heart conditions to dialysis for renal failure to various medications for the treatment of ongoing musculoskeletal pain, is routinely reimbursed by third-party payers for incurable conditions, ongoing chiropractic care for degenerative disc disease and osteoarthritis in chronic low back pain is routinely denied. This despite the direct costs of LBP having been estimated at $12.2 billion to $90.6 billion annually in the U.S., or $45 to $335 per person each year.1 It's not fair!
Over the past 100-plus years the chiropractic profession has generally matured outside the health care area, tending to isolate itself from the other health care professions. While this isolationism has helped chiropractic survive, it has also allowed chiropractic to develop its own lexicon of terminology outside of mainstream health care. However, as we now enter the modern era of electronic health records and their meaningful use mandate that requires sharing with other health care disciplines, it will become increasingly important that all providers speak a common language.
The ACA's Insurance and Managed Care (IMC) committee was among the first to recognize the need to update the policy language utilized by chiropractors in order to address the evolution occurring within the profession. The original language, e.g., "supportive care" and "maintenance care," developed as part of the Mercy Guidelines project in the early 1990s had become marginalized by the third-party payer system over the interim.
Therefore, in light of national health care reform and its focus on evidence-based care, the ACA IMC turned to the Council on Chiropractic Guidelines and Practice Parameters for assistance in addressing this language issue. The CCGPP has been accumulating and collating evidence across the spectrum of chiropractic care over the past five years in an effort to better position the chiropractic profession within the health care arena. Seed statements were developed regarding the typical phases of patient care and a multidisciplinary panel was convened to define the scope of chiropractic care.
The resulting paper, published in the July/August 2010 issue of JMPT, is titled "Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent, and Wellness."2 This paper defines and describes appropriate care throughout the spectrum of typical chiropractic patient encounters, providing perspective relative to other health care conditions and treatment modalities. Those stages of case management are defined as follows:
Care of Acute Conditions
Care of Chronic/Recurrent Conditions
Care for Wellness
With proper definition of the patient's stage of care based on the above and documentation, there is now good scientific evidence substantiating appropriate chiropractic care for your patients. The CCGPP has also developed "Management of Chronic Spine-Related Conditions: Consensus Recommendations of a Multidisciplinary Panel,"3 a guideline to assist doctors in the management of chronic/recurrent patients. (The application of this new chronic/recurrent care guideline will be the subject of a future article.)
It is imperative that the chiropractic profession adoapt and employ these definitions in daily use as they document their patient encounters. In so doing, individual doctors of chiropractic will leverage the work of the CCGPP and the ACA in integrating chiropractic care into the evolving and emerging national health care reform.
As Hubert Humphrey stated, "In real life, unlike in Shakespeare, the sweetness of the rose depends upon name it bears. Things are not only what they are. They are, in very important respects, what they seem to be." Doctors of chiropractic, the nation's spinal health care experts!
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
