Finally, after one hundred years, it seems chiropractors received support from the United States government with the December 1994 publication by the Agency for Health Care Policy and Research, “Acute Low Back Problems In Adults-Clinical Practice Guidelines.” Not really! Despite the fact that chiropractors provide the majority of spinal manipulative therapy, the publication referred to spinal manipulation therapy, not chiropractic care.
It should become obvious to managed care organizations that spinal manipulative therapy will improve the quality of care for neuromusculoskeletal disease, including back pain, neck pain, and headaches. Access to spinal manipulative therapy will prove effective with decreased costs, increased patient satisfaction, and reduced disability for low back problems. Who will be the spinal specialist for these managed care organizations?
May I submit that the most likely provider may be the Doctor of Osteopathy. Why, you may ask? The osteopathic physician is licensed to provide primary care, including the use of pharmaceuticals and spinal manipulative therapy. Usually these providers are board certified and integrated into the health care delivery system. Whereas, the Doctors of Chiropractic are usually not board certified, certainly not licensed to prescribe pharmaceuticals, and most often not integrated into the health care delivery system. Certainly, these deficiencies are problematic for our profession.
Due to the current status of the chiropractic profession, I propose some action steps that may better position DCs in the managed care world. Interested chiropractors should:
- Enroll in a course that provides board certification as a “Spinal Specialist.”
- Acquire adequate professional liability insurance ($1,000,000).
- Join international, national, and state professional associations.
- Apply to your local hospitals for staff privileges.
- Support any legislation that requires chiropractic services in managed care.
It is conceivable that Doctors of Chiropractic may be utilized as a specialty service provider for the diagnosis and treatment of neuromusculoskeletal disease in managed care. Completing the above suggested action steps would be beneficial, but other obstacles are to be overcome by this profession. The realities of managed care include the necessity for chiropractic providers to integrate into the health care delivery system. This process involves acceptance by both the managed care organizations and the primary care providers. Internal treatment guidelines will allow or prevent referral to doctors of chiropractic for spinal manipulative therapy of neuromusculoskeletal disease.
Due to our one hundred years of isolation from the medical profession, integration and designation as “spinal specialists” will be cumbersome and problematic. As members of the chiropractic profession, we are obligated to improve access to chiropractic spinal care within the managed care system. Subsequently, each of us should make the extra effort necessary to integrate chiropractic services into the current health care delivery system.
James Joseph Lehman, DC, DABCO of Albuquerque, New Mexico is a 1972 graduate of Logan College of Chiropractic where he also received his certification in physical therapy. Dr. Lehman presently is a Consulting Research Scientist for The Lovelace Institute and is in private practice with Spine Centers of New Mexico. Please contact Dr. Lehman at 505-299-7077.
