How do you feel managed care is impacting the individual practitioner?
I think managed care has had a negative effect on practitioners of all disciplines, not just chiropractors, but MD’s, DO’s, podiatrists, optometrists the whole health care delivery system has felt this impact.
In what ways do you feel it’s been negative?
It certainly has been a problem for those DC’s getting on the panels with HMO’s, PPO’s or any managed care entity. They naturally don’t take everybody in the community. A good example: we’re close to Disney World and a lot of the chiropractor’s patients around here are Disney employees. When Disney went to managed care those DC’s saw some of their patients just disappear.
Do you see any positive benefits?
The only positive benefit is for the business community because it saves them money and cuts down on their insurance premiums.
What kind of practices do you tell DC’s to develop?
We encourage our members to get on as many managed care panels as possible. In fact, in an effort to help our members in this era of managed care, the FCA initiated the formation of a statewide chiropractic PPO which is called PCPI: Preferred Chiropractic Physicians, Inc. and it is a statewide not-for-profit managed care PPO. We try to stay abreast of what’s happening and offer our members a first class chiropractic PPO.
What does it cost to join a managed care organization?
I have seen some as much as $2,000 a year and these are the for-profit chiropractic managed care companies. PCPI is not-for-profit and the membership is only $295 per year; any of our members can join. All of the monies raised by PCPI go strictly for administrative and marketing, to get as many contracts with HMO’s and other managed care entities for those members to join.
What kind of credentialing requirements are required to join?
They fill out an application and their background is then checked. PCPI pays for an outside credentialing corporation to complete that part of the process, just like any other managed care entity.
Are you aware of any practices that have increased their net earnings through managed care?
With the reports I get through our membership I find it hard to believe that any individual practice has increased with managed care because the complaints we get are that even when they’re in these contracts, they have to take a lesser rate for service than what they’ve been accustomed to being reimbursed.
The whole idea of managed care, especially with capitation is they promise high volume and you can charge less, but the problem with so many of the HMO’s is they try to use the least amount of chiropractic physicians that they can and still stay within the law. Here in Florida, we have very good state laws for chiropractic; HMO’s must provide chiropractic care to all of the subscribers. However, they meet the technical requirements and may have 200-300 MD’s on the panel and only 2-6 DC’s. So that’s one of the areas we have difficulty with.
How should DC’s get educated on managed care?
It’s best to stay on top of things and stay on the cutting edge with what’s going on. Attend all the seminars, read what you can, talk to your colleagues who are heavily involved. We have had speakers at all three of our annual conventions on managed care.
Do you feel managed care will continue evolving or stay about the same?
I think it’s going to evolve for maybe another year or two and then I predict we’re going to see a downward spiral back towards the way it used to be with fee-for-service. You can already see a lot of disenchantment with the patients in managed care because managed care is not the best of health care. I think you’re going to see a kind of patient revolt and I predict within 5 -7 years it’s going to be similar to the way it was before managed care.
What advice do you feel is appropriate for DC’s who aren’t currently in a managed care plan?
I like to go by the old saying, “When in Rome…” I urge DC’s to get on as many plans as possible. I wouldn’t sit back and wait. I wouldn’t keep my head in the sand like an ostrich because the average person who goes to the doctor likes for someone else to pay the bill for them.
Everything comes in cycles and this, too, shall pass.
