"Every patient is not 'worth' a certain dollar amount"
I was less appalled to read about a 24-visit cap in California [www.chiroweb.com/archives/21/22/17.html] than to read the reference to the LA Times article about Safeway's analysis on overutilization in California, compared to other states. Here in Washington, we have a 20-visit "soft cap," but my visit average falls way below that, with patients returned to work without sequelae.
I used to practice in California, and was amazed at the amount of care (60-plus visits) being paid for in workers' comp for lumbar strain injuries, with no repeat examinations, and no referrals for second opinions. This was theft, pure and simple. It was no different than the brochures I saw in Mexican restaurants that explained in Spanish how to obtain disability in California.
If we want to gain respect in the health care arena, we would do well to review all the studies that show how effective chiropractic care is and how many visits it takes, on average, to get a given condition asymptomatic, and strive to make this our average utilization. When care starts to exceed this, refer for a second opinion. Every patient is not "worth" a certain dollar amount. If a practice consultant suggests this, throw him/her out of the office and the profession.
For those of you who feel everyone needs a chiropractic visit a week for life, remember: Health insurance providers and workers' compensation payors assume you are submitting claims for care related to an ongoing injury they can document and validate. Moral behavior needs to be a part of all our practices. Set it aside, and we will all be sidelined from the health care arena.
Les Peterson, DC
Arlington, Washington
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