A Chiropractic SWOT Analysis: Part One of Two

A SWOT analysis is a useful tool for auditing organizations and the environment they exist in. It is an important stage in developing a plan for the future and helps the participants focus on key issues. SWOT stands for strengths, weaknesses, opportunities and threats. Strengths and weaknesses are considered factors internal to an organization. Opportunities and threats exist in the external environment.

For this article, I've been asked to apply the process of SWOT analysis to the chiropractic profession. The future will require our profession to embrace change. My hope is to stimulate a dialogue between you, your chiropractic colleagues and your chiropractic team members and to help our profession formulate a plan of action for the years ahead.

Our Strengths

Chiropractic is Conservative, Low-Risk Care
Chiropractic care is conservative and is delivered by doctors of chiropractic who maintain excellent clinical relationships with their patients. This conservative approach, along with the close monitoring and management of our patients' progress, allows chiropractors to avoid the costs of uncoordinated care and redundant services. In many cases, chiropractic care enables patients to avoid surgery, eliminating the costs of hospitalization and extended time off work for convalescence.

A substantial number of scientific studies from around the world support the assertion that chiropractic care is effective and can reduce the costs of care for many disabling and expensive conditions. The relative low cost of chiropractic malpractice insurance, as compared to that of our medical colleagues, is a testament to the safety of chiropractic care.

Chiropractic Patients are Highly Satisfied with Care
Multiple studies report that chiropractic patients' satisfaction with their care is among the highest in health care. A 2009 Consumer Reports survey showed that chiropractic rated highest among patients in satisfaction of relief from back pain. The survey noted that 80% of U.S. adults report having back pain some time in their life. Of those responding to the survey, chiropractic received the highest grade with 59% saying that they were "highly satisfied" with their results. More recently, according to a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from doctors of chiropractic. When asked to rate their satisfaction on a 10-point scale, 87% of patients in the study gave their doctor of chiropractic a level of 8 or higher. What's more, 56% of those patients rated their chiropractor with a perfect 10.

Chiropractic's Marketing and Public Relations Efforts are Effective
The profession's longest established and most effective marketing and public relations effort, the Foundation for Chiropractic Progress, reached a milestone of 3.5 billion positive impressions about chiropractic in the main stream media during the past year alone. Since its inception, the Foundation has had one message, "Positive Press for Chiropractic." To date, thousands of chiropractors, chiropractic students, chiropractic patients, over forty State and National Associations, and dozens of chiropractic vendors support the Foundation through monthly contributions. This year Ret. Brig. General Rebecca Halstead, the first female graduate of West Point, and Jerry Rice, NFL Hall of Famer and Dancing With the Stars contestant, agreed to extend their status as the profession's spokespersons to carry forth the chiropractic message via, radio, print, television and through personal appearances. To learn more about the Foundation, visit www.foundation4cp.com.

Chiropractic Leadership is Unified in Purpose
The Chiropractic Summit was created in September 2007 in recognition of the profession's desire for unity. The first Summit meeting, held in Washington, D.C., was comprised of 13 organizations; four years later, the Summit has 41 members, representing leadership from education, research, regulatory bodies, political action, practice management, chiropractic media and national associations, including the ACA, ICA and WCA. This November, the Summit met for an historic fifteenth time. The Summit provides a vehicle through which our national organizations can share their varied opinions in a confidential setting with the goal of presenting a unified message to legislators and policy makers for the good of the profession and our patients. To learn more about the Summit and to be kept informed about important health care issues visit www.chirosummit.org.

Chiropractic is the Most Utilized CAM Profession
Chiropractic has an approach toward health, prevention and wellness that more and more of the general public are embracing. Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. Patient surveys show that chiropractic is used more often than any other alternative provider group. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades. According to a Harvard Medical School study, published in the Journal of the American Medical Association in 1998, 42% of Americans use some combination of complementary/alternative therapies in conjunction with conventional medicine. Some researchers estimate that the number may currently be as high as 70%. In addition, Americans spend more on these therapies than all out-of-pocket spending for U.S. hospitalizations.

[pb]Our Weaknesses

Chiropractors are Slow to Comply with Regulatory Changes
The regulation of the health care industry has increased considerably over the past few years and some chiropractors have been slow to comply with the new requirements. The Office of Inspector General (OIG) released the final Compliance Program Guidance for Individual and Small Group Physician Practices over a decade ago. The OIG Compliance Program was a guidance that included the steps to perform voluntary self-audits to help health care providers and suppliers avoid submitting erroneous claims and engaging in fraudulent conduct involving federal health care programs. The era of voluntary health care compliance came to an end with the Patient Protection and Affordable Care Act's (PPACA) mandate requiring all health care providers to implement formal compliance programs as a condition of their enrollment in federal health care programs. Yet many chiropractic practices have not implemented the OIG Program including the selection of a Compliance Officer, staff compliance training, self-audits, correction and reporting. PPACA also saw the advent of HITECH HIPAA (Health Insurance Portability and Accountability Act) which brought new regulations concerning Protected Health Information (PHI). Many chiropractic practices have not yet upgraded their old one page Notice of Information Practices and implementation procedures to the new nine page HITECH version.

Chiropractors Need Improvement in their Documentation Skills
According to the most recent OIG report on "Inappropriate Medicare Payments for Chiropractic Services," published in 2009, Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47% of claims meeting the study criteria. Business Insurance Magazine estimates 5%-10% of all BCBS claims are paid incorrectly, which is echoed by Aetna's estimate of 11% payment errors. In the era of the post-payment audit, it is vital for you to support the medical necessity of the care you deliver by objectively documenting your patients' functional improvements. Functional improvement refers to the effectiveness of the care delivered in improving patients' ability to carry out their activities of daily living. Outcome-based documentation validates patients' subjective complaints to third-party payers and improves patients' motivation to follow through with your recommendations for care by assisting you in establishing clearly defined goals for care.

Chiropractors Have Been Slow to Embrace EHR
The buzz about how electronic health records (EHR) will transform health care delivery in the United States keeps growing. The federal government and the Centers for Medicare and Medicaid Services (CMS) brought increasing attention and urgency to the issue with the HITECH Act (the Health Information Technology for Economic and Clinical Health Act). HITECH provides for federal stimulus money to be paid to eligible health care professionals (including chiropractors) for implementing and using certified EHR products. Those chiropractors who implemented an approved EHR and used it "meaningfully" beginning in 2011, are eligible for significant bonus payments from Medicare, up to $44,000. The first incentive checks have been mailed and early-adopter chiropractors have already received the maximum first year payments of $18,000 from the EHR stimulus program. HITECH is ambitious and has a fast timeline. Those chiropractors who do not implement a certified EHR system in their practices in a timely fashion risk losing a portion of the incentive payments. Those who wait until 2015 will see the incentive change into a penalty, as an increasing percentage of their Medicare payments are deducted for non-compliance.

Chiropractors are not National Organization Joiners
There are approximately 60,000 doctors of chiropractic in active practice in the United States and yet the combined membership of all our national organizations is less than 18,000. Compare this to the AMA's current membership of approximately 209,000 members. The economies of scale are not in favor of the chiropractic profession.

The AMA has an annual lobbying budget of tens of millions of dollars and during the health care reform debate, the AMA contributed on a scale that made it one of the largest political contributors in American history. The arguments made by some chiropractors for not joining a national organization are varied, but follow common themes. They wonder if membership can impact their own practice ("What's in it for me?"); they perceive bickering and disunity on a national level and don't want to partake; they perceive that if they belong to their state association, they don't need to support a national organization.

"United we stand, divided we fall" is a phrase that has been used in mottos from nations and states to popular song lyrics. Chiropractors would do well to heed its wisdom.

Next Month: Opportunities and Threats.