Chiropractic is at War with Predatory Managed Care

The past decade has seen a staggering rise in abusive practices by some chiropractic managed care organizations (MCOs). These MCOs have violated the trust placed in them by patients and the chiropractors that serve them by implementing a series of predatory practices and skewed policies designed to inappropriately limit needed patient care. They financially exploit business relationships established with doctors of chiropractic recruited or forced into joining their networks. Arbitrary caps are routinely placed on numbers of visits based solely upon financial measures regardless of physical findings or medical necessity. Well-intentioned chiropractors are penalized if they provide a full course of treatment and expelled from the network if they complain or fall outside of practice patterns that inappropriately reduce care. In addition, aggressive post-payment audits are employed by MCOs as a means of increasing insurance companies' profits by extracting money previously paid to chiropractors. The National Chiropractic Legal Action Fund (NCLAF) is deeply involved in helping encourage and advance a multi-state investigation by state and federal authorities exploring whether laws were violated by the activities of predatory MCOs.

Chiropractic has a Shrinking Middle Class

As the Great Recession of 2007-09 finally winds down, many chiropractors face diminished lifestyles, with no obvious way to regain the wealth and prospects they enjoyed just a few years ago. The number of top and bottom performing practices has increased while the middle class of chiropractic practices has shrunk. It's natural to hope for a return to the familiar trappings of pre-recession practice and its steady improvement in living standards. Some may still find that. But a growing number of chiropractors find themselves unable to recover, even as the economy returns. Scarce credit, mounting debt, new technological demands, and the increasing cost to run a practice are stunting the growth of some chiropractic practices and inhibiting the "creative" part of the "creative destruction" caused by the recession. Some experts say the profession didn't experience a recession but a "transformation".

Chiropractic College Enrollment is Decreasing

One report suggests that total U.S. chiropractic college enrollment fell from a high of 15,398 in 1996 to just over 10,000. This 5,000-plus drop represents a 35% decrease in student enrollment overall. Many factors may be responsible for the decline including demographic trends, lack of referrals by disenchanted chiropractors and the diminishing financial return on the cost of a chiropractic education. The cost of a chiropractic education is approaching $150,000. This places it beyond the ability of many potential students to manage the debt they must assume. Our institutions of higher learning must focus on how to educate students more economically and better prepare them for the real world of practice that they will confront upon graduation. The American Medical Association Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy medical students. What would it do to enrollment if chiropractic provided a similar incentive?

Chiropractic Lacks Research on Quality of Life Measures

While chiropractic has excellent research supporting the cost-effectiveness and efficacy of care for headaches as well as neck and back pain, the future of our profession both in the realms of legislation and reimbursement hangs on our ability to perform and publish research supporting chiropractic's ability to produce positive health-related quality of life outcomes. Standardized health-related quality of life (HRQOL) measures are critical for a number of purposes, including evaluating the nation's progress in achieving population health goals, assessing health disparities across different segments of the population, and measuring the effectiveness of health care interventions for age-related diseases. As EHR adoption makes available massive quantities of health care data for analysis, the comparative effectiveness of care as it impacts the quality of life will drive both reimbursement and public policy. The outcomes produced by chiropractic care will be compared to those produced by all other disciplines. Our ability to document that chiropractic has a positive impact on the overall quality of life, health and wellness through published, peer-reviewed research is essential to the future of our profession.

Chiropractors Must Take Personal Responsibility

The failure to take personal responsibility for the future of the chiropractic profession is the greatest threat confronting the profession. A key difference between successful individuals and unsuccessful ones is their readiness to take responsibility for the events of their own lives, as well for others in the realm of their influence and authority. Taking personal responsibility, as opposed to placing blame, is the difference between victors and victims. The victors see themselves as a creator of events and circumstances, whether good or bad. Don't sit idly by hoping that someone else will come to the rescue. Embrace change by deciding that you are the one who is going to make a difference.

Applying SWOT

The next step in the SWOT process is called matching and converting. Matching is used to find competitive advantages by matching strengths to opportunities. Converting is to convert weaknesses or threats into strengths or opportunities. I hope that you will take some time to complete this exercise on your own or with your colleagues. I have never been more excited about the possibilities for the future of chiropractic. This is our opportunity to make massive gains in a time of unprecedented change. It is time for our profession to shine!

Dr. Mark Sanna, a 1987 graduate of New York Chiropractic College, is a member of the ACA Governor's Advisory Board and a member of the President's Circle of NYCC and Parker College of Chiropractic. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com).