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Behind the Walls of Managed Care

Dear Editor:

I would like to respond to some of the comments in Dr. Friesen's letter to the editor in the Jan. 15 issue providing insight from within managed care. [See "An Insider's Look at Managed Care," which is a response to Dr. Richard Cole's article, "The Moral Dimension of Network Participation: Let's Stop the Abuse," published in the Sept. 9, 2011 issue.] First, it is clear that our profession need to improve the documentation of complaints and treatments within our offices. The inherent problem here is that we give our patients their lives back and this does not always correlate with increased ROM, decreased spasm (however, we would be expected to track this) or lowered VAS. For headaches alone, we have frequency, duration and severity. This does not correlate well with any of the three markers noted above.

Certain TPAs actually set the required visits for authorization below the average number of visits. This basically asserts that the average chiropractor treating the average patient needs to be managed. I realize that there have been insurance abuses within my profession, but I'm equally as confident that the average DC treating the average patient is not a part of that equation. So, you can understand my profession's confusion as to why the requirements are punitive to all providers.

And lest someone in a TPA management thinks additional paperwork, on top of our office notes, to get paid drastically less is not punitive, then it's been a very long time since they've been in private practice.

Some of the TPAs that get inserted into the direct relationship between and insurance company and the physician are problematic, to say the least. First of all, in all cases there is a drastic cut in reimbursement; in almost all cases that I've seen it is actually below the cost of providing the service. From a provider's standpoint, this is predatory.

To suggest that contracting with an insurance company is an individual decision is a despicable comment by Dr. Friesen, given that his company is quick to use federal laws that are inherently imbalanced against the provider to oppress anyone who tries to share their opinions on network participation. It is akin to throwing that fact into the face of the helpless provider. It's funny how when two or more providers get together, it's anti-trust, but when a single TPA directs pricing for a majority share of the market, it's OK.

So, Dr. Friesen, thank you for the insight into what it is like behind the walls of managed care. When you have time, I'm sure any provider would love for you to spend a week in their devastated practice (which had been running just fine prior to the introduction of the TPA) to get a better feel for their end.

James Bogash, DC
Mesa, Ariz.

Patients Deserve to See Doctors Who Have Options

Dear Editor:

If ever there were a persuasive article about why chiropractors should have prescription privileges it was Donald Petersen's potent piece on the number of deaths attributed to prescription medications ["Every 14 Minutes ... Someone Dies From Prescription Drugs," Nov. 18, 2011 issue]. While our formulary doubtless would exclude such things as fentanyl and oxycontin,with prescription privileges we would have the authority to advise our patients on alternatives to such drugs and even assist them in weaning off ... instead of the discussion I've had with many patients who come to my office on unbelievable quantities of medications:

"If you feel that chiropractic is helping your pain or if you feel that the meds are not helping enough, I suggest that you schedule a visit with your medical physician to discuss your meds and dosage." (You can imagine what the result of that visit might be.) I would have the authority to help manage that from chiropractic's more conservative approach.

Patients deserve to see physicians who can offer the widest possible number of options, including natural and safe alternatives. In other words, a chiropractor.

Cathlynn Groh, DC
Denver, Colo.

Let's Fight for a Logical Health Care System That Works

Dear Editor:

For years I've wondered why chiropractors cower to the power of Western medicine when we have so much ammunition to use against them, and they have virtually nothing to use against us. Sure, they're better funded than we are, but we don't need to beat them in court or win the lobbying game. The only place we need to beat them is in the court of public opinion.

It seems to me that all we would have to do to move this country into a wellness model is let people know how ineffectual, backward and dangerous Western medicine really is, while at the same time letting them know that nature heals, provided all interference is removed. We natural healers specialize in detecting and removing interference, whether we do so with adjustments, nutritional supplements, herbs, needles, etc. It is they (the purveyors of drugs and surgery) who have always been the quacks in this tale.

Just looking at their record tells you this. JAMA admits to their killing of 280,000 people per year, while admitting that this is probably only about 5 percent of the true number! I feel it is our duty to get this information out to the public at large.

America has the most expensive and least effective health care system on Earth and we are the way out of this trap. As people who care deeply about the health of our species, why wouldn't we warn the public about the biggest cause of sickness and death out there? In my opinion, it would be negligent not to. Just as we feel it is our duty to warn patients about the evils of too much sugar, processed foods, lack of exercise, etc., why wouldn't we warn them of the inherent dangers of using drugs and surgery?

Are we afraid we'll be attacked? We're under a constant low-level attack as it is. Who do you think is behind all the anti-chiropractic propaganda? Remember the AMA Committee on Quackery's mission: To control and eliminate the "chiropractic menace"? Well, it's time for the tables to turn. They are the quacks; it is Western medicine that is the menace to society.

This is not about "getting them back," though; this is about public health. It is my belief that putting toxic chemicals into the human organism weakens that organism, and if done over time, that person will become sick. It is my further belief that in order to be fully healthy, we need all the organs we were born with, and to remove any of them unnecessarily would constitute malpractice. Therefore, why wouldn't I educate people on the hazards of a system that focuses on using these harmful practices?

The only reason I can think of, besides the fear of retribution, is professional courtesy. Well, I think that is a bogus reason. In fact, I'd say that it's downright immoral. Do you think for a second that if we were killing 300,000 people a year that the medical profession would extend this same courtesy to us? If there were even an inkling that we had contributed to epidemics like autism, do you think they would allow that information to rest with them? In fact, our silence on these matters almost makes us complicit in the crime, doesn't it?

Are we seriously hoping that if we don't tell on them and just keep churning out research showing chiropractic relieves back pain, they will accept us into their club and consider us their brothers and sisters in the healing arts? Keep dreaming. If/when they do accept our "nonscientific" methods, they're not about to admit we were right and they were wrong; they'll simply co-opt our methods as their own, or see to it that physical therapists are licensed to adjust the spine (as is already happening) and use them as the musculoskeletal arm of allopathy. And when that happens, we will become a superfluous profession.

Since we don't own or control the adjustment (as they own/control drugs and surgery), having more peer-reviewed research on spinal manipulation may not necessarily be in our best interest – unless at the same time we're proving chiropractic works, we're also proving that Western medicine is dangerous and based on an outmoded way of thinking.

Drug companies don't do research on anything they don't hold the patent on because it's not financially sound to spend money researching something anyone can sell. But we do this in chiropractic all the time. I'm not saying we should stop doing research on the adjustment, but we might spend a little of our "research money" or Foundation for Chiropractic Progress money on explaining to the public what a hazard drugs and unnecessary organ removal are to the human body.

What's nice is we can just present the very credible research that's already been done by allopathic medicine. This damning stack of evidence should be presented as a public-service announcement; not as advertising for chiropractic. The goal is simply to get the word out that Western medicine is dangerous and should only be used in crisis situations like emergency medicine, for life-threatening bacterial infections, and for the management of conditions like insulin-dependent diabetes. For all other conditions, including wellness and prevention, more conservative measures like detoxification, nutrition and chiropractic are the logical choice. This is responsible, logical health care.

That's what we should be fighting for – a logical system of health care that actually works. And unlike the Committee on Quackery, this should be done with total transparency. As long as our motives remain pure and the information is presented rationally, responsibly and accurately, no one could ever fault us for this. In fact, we would be viewed as the leaders in natural health care.

What the hell are we waiting for? What can they possibly do to us that hasn't already been done? Join me in the natural health care revolution and help educate the world on what a logical health care system would look like.

Brad Case, DC
Prunedale, Calif.

Dynamic Chiropractic encourages letters to the editor to discuss issues relevant to the profession and/or to respond to a previously published article. Submission is acknowledgement that your letter may be published in print and/or online. Please submit your letter to editorial@mpamedia.com; include your full name, degree(s), as well as the city and state in which you practice.