The next trend in the years ahead is one of the rise of chiropractic philosophy to the forefront of health care.

Those practitioners that master combining a subluxation-based chiropractic practice with a multidisciplinary setting will become the predominant force in the delivery of non-crisis health care to our nation's population. These practices understand that health comes from the inside out, and not from the outside in.

The primary direction in health care is one away from the traditional passive model of patient care toward an active model of care. The paradigm of passive care with which chiropractors have practiced since the inception of the profession is now defunct. Many practices that were established years ago are closing their doors due to the fact that they have not recognized the need to shift their paradigm to active care.

In the active paradigm, your patients actively participate in the healing process. The passive model is one where patients lie passively and receive treatment modalities applied by a physician or therapist.

Active care means giving therapeutic procedures a role in your patient care plan. The definition of a therapeutic procedure is, "a procedure applied one-on-one by a therapist or physician to improve function." The operative word in this definition is function, the language of the active paradigm, and hence the language of reimbursement, is function. By employing therapeutic procedures and learning the language of function, you will be adopting the most powerful new paradigm.

Active care is outcome driven.

Effectively employing outcome assessment tools helps you establish the rationale for your care. You must systematically deploy the outcome assessment tools of the Oswestry Questionnaire, Neck Disability Index, Visual Analog Scale, Symptom Diagrams and others, in your practice.

It is not enough for you to get your patients well and to return them to normal health; you must prove that you have done so. These tools allow you to effectively establish and communicate functional goals for your patients' care. These functional goals will become the benchmarks for your care.

How you document the improvement of your patients' ability to perform their activities of daily living establishes the medical necessity of your care. In most cases, an insurance carrier's definition of reasonableness and necessity are linked to whether the treatment provided has helped to return your patient expeditiously to a state of well-being. Your documentation drives reimbursement. Effectively employing outcome assessment tools is one method of establishing the medical necessity of your care.

Reimbursement and The Rise of the Machines

Chiropractors practicing in a passive paradigm submit claims to insurance carriers filled with day after day of "MUSH." "MUSH" stands for the passive modalities: Manipulation or Mechanical traction, Ultrasound, Muscle Stimulation and Heat. Visit after visit of "MUSH" submitted to an insurance carrier produces mush for reimbursement!

You must master the tools of reimbursement. A comprehensive understanding and ability to correctly employ CPT and ICD codes is the next vital trend that you must be aware of. When you submit an insurance claim for reimbursement, you are initiating a dialogue with a computer program.

The language in which computers communicate is numbers. A mastery of these numbers will allow you to communicate what it is that you have done and at which level you should be reimbursed, not to a human being but to a machine. You must know how to code for what you do, and how to appropriately apply modifiers to those codes, to receive the level of reimbursement that your patients deserve.

Worst Competition

Chiropractors can be their own worst competition. The mind set that there are not enough new patients to go around limits growth and stifles opportunity. Every man, woman and child on the planet today has a spine and needs a chiropractor. Eliminating the thought that medical physicians, physical therapists, massage therapists, or other alternative practitioners are your competition is the first step to unlimited new patients.

Chiropractors should seek to become proficient in the techniques of their choice and to deliver the highest quality care possible. When you are the best, there is no competition! Focus on polishing your patient communication skills so that you can confidently express your message at every opportunity. Placing the focus on these two important skills will leave you with little time left to worry about the "competition."

To paraphrase Charles Dickens, these are the best of times and these are the worst of times to be a chiropractor.

The trends that are moving ahead at rapid speed are all in alignment with this powerful new paradigm for chiropractic. It's as though all of the planets have lined up at precisely the correct celestial position at precisely the correct time for you to participate in the complete realization of your vision. Opportunities are abundant for those who align themselves with professionals who can support and guide them in achieving their goals. You must focus all of your attention on mastering these new trends.

The future has arrived and the time is now for you to invest in the new paradigm as a part of your over-all success strategy.

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).