Dr. Joseph Sasso explains why he believes the chiropractic practice of the future is a high volume, low fee, cash practice functioning outside the limits imposed by HMOs, PPOs and other third party payers.
In June 20, 1995, a speech was delivered before the Council on Chiropractic Education by Dr. Lawrence M. Jack, a chiropractor who is the Medical Director of Chiropractic Services for MetraHealth, a national HMO. MetraHealth bills itself as the largest HMO in America, therefore making Dr. Jack one of the most influential chiropractors in third party reimbursement today.
I would like to share some of the concepts advanced by Dr. Jack in his CCE speech. I believe such a scenario would be detrimental to all chiropractic practices. I also believe that only the objective straight chiropractic practice can survive Dr. Jack’s vision for the future of chiropractic.
The Corporatization of American Health Care
First, Dr. Jack identifies one megatrend occurring in American health care today…The U.S. is now witnessing the “corporatization” of American health care. Large payer groups are teaming up with the largest providers by channeling patients to PPO’s. There is growing evidence that corporate America, and the U.S. government are prepared to sacrifice patient choice to gain lower health care costs.
This concentration of patients into the largest organized systems of care is having the effect of squeezing out independent practitioners because it eliminates the fee-for-service approach to purchasing health care.
With the emphasis of the health care organizations shifting away from fee-for-service and toward capitation (where flat monthly fees are charged), the logic, the incentives and the conduct of all the players is reversed.
Currently, there exists a reward for volume. The more patients seen, the higher the financial reward. Most hospital and physician revenues are realized under reimbursement formulae which positively reward them for more patients, more tests, more diagnoses, etc.
However, in shifting to an integrated or HMO-type system, the financial rewards for practitioners are then realized by seeing fewer patients, recommending fewer tests and finding fewer problems.
Here hospitals are concerned, profits are increased by fewer admissions, shorter lengths of stay, increased out-patient treatments and fewer referrals to specialists. This reversal of incentives has not gone unnoticed by consumer advocates nationwide.
Here in New Jersey, Department of Consumer Affairs Director Mark Herr, along with the Board of Medical Examiners are worrying aloud about the influence third party payers are exerting over patient care. A January 22, 1996 Asbury Park Press editorial states, “Some HMO’s give doctors bonuses for limiting patient visits, treatment by specialists and trips to the emergency room. HMO’s and managed care insurers’ focus on the bottom line can be carried too far. Health care consumers are usually in the dark about these arrangements because insurers bar their providers from telling patients. Based on testimony from medical providers, such gag orders seem to serve only one purpose: to keep patients from learning that they are receiving less than optimal care.”
All of the above (fewer admissions, fewer tests, finding fewer problems) are decisions under the doctor’s exclusive control. Therefore, MD’s respond to capitation with relatively little trouble. They simply change their practice behaviors. Some estimate that 80% of future cost savings will be realized through modified physician conduct, not greater hospital efficiency.
How HMO’s View Chiropractic
Benefits officers for managed health care systems look at chiropractic very matter-of-factly, very unemotionally. When making the decision to include or exclude chiropractic services for enrollees, it’s strictly business.
The practice of chiropractic is perceived as uncontrolled and unmanaged. With uncontrolled or unmanaged services, the costs are not predictable-the last thing an HMO wants! Therefore, chiropractic is considered a luxury benefit, not a vital one.
To compound the problem, the chiropractic profession is perceived as not having the ability to contract with third party payers as a whole. Therefore, those who determine benefits can generally ignore chiropractic as a covered service without fear of it being perceived as insensitive or they as uninformed.
In addition, the chiropractic profession is perceived as not being capable of engaging in any significant offensive battle legislatively, judicially or scientifically because of the lack of funds, data, protocol or accountability.
From the perspective of those who decide what will be included in HMO benefits, there is absolutely no argument for the inclusion of chiropractic.
The “Best Case Scenario” for Chiropractic?
Dr. Jack develops a “best case scenario” that he thinks will allow chiropractors to survive within the mega HMO’s of the future.
This scenario can best be summarized by controlling chiropractic practice. He suggests, chiropractic practice be limited by defining its scope as: identifying the primary neuromusculoskeletal injuries and conditions, determine whether the case is complicated or uncomplicated and identify where the problem is located (cervical, lumbar, etc.)
If the profession could be coerced into following Dr. Jack’s best case scenario, the majority of chiropractors practicing today would need to find another means of employment. Jack reports that there are 52,000 chiropractors in the U.S. today and that, under his best practice model, only 12,000 would be needed!
Objective Chiropractic’s “Insurance”
Dr. Jack’s best case scenario is completely invalid in my opinion. I, and many others, believe that the chiropractic practice of today and the future, is a high volume, low fee, cash practice functioning outside the limitations imposed by HMO’s, PPO’s and other third party payers. Clearly, I am speaking of an objective straight chiropractic practice. The practice whose singular objective is the correction of vertebral subluxations. The practice that leaves diagnosis and therapy and all other mechanistic approaches to health in the hands of others.
A few years ago, when the straight chiropractic community (led nationally by the Federation of Straight Chiropractors and Organizations-FSCO and locally by the Garden State Chiropractic Society-GSCS) advocated and made available the training and tools necessary for chiropractors to function independently, to deliver quality chiropractic care at reasonable fees and, most importantly, to do so on their own terms, many in the profession snickered and scoffed and tried their best to simply ignore this common sense approach to the problems of spiralling health care costs and undue, unwarranted outside intervention into the sanctity of the doctor/patient relationship. When the FSCO denounced compliance with the “Mercy Document” as the “incompetent practice of straight chiropractic,” few took notice.
Wow, in order to both meet the needs of today’s health care consumer and to simply sustain themselves professionally, these same individuals are seriously and carefully re-examining their professional objectives and methodologies for congruence and necessity. Remember, the odds are 4 to 1 that you won’t make it under managed care (according to Dr. Jack’s best case scenario).
I believe the American public is perfectly postured to receive the vitalistic chiropractic paradigm objective straight chiropractic offers that states the body is a self-healing, self-regulating mechanism that will always function at a higher level when kept free from vertebral subluxation.
Consider what Americans already buy outside of the managed care systems. Americans are willing to pay more for “low fat” or “high fiber” foods without thought of insurance reimbursement, because they think these purchases will contribute positively to their health.
Millions of Americans hold memberships in exercise clubs, even though they know their insurance will not pay for it, because they believe their membership will contribute positively to their health. Pure drinking water is a multi-billion dollar business for the same reason: the public is willing to pay for what it desires, particularly if there is a perception of positive influence on their health. Americans are devouring self-help books and motivational tapes offered through glossy infomercials at an astronomical pace. (Do you know anyone who hasn’t read The Celestine Prophecy or any of Deepak Chopra’s works?) All because there is a perception of positive influence on their health and none of it covered by insurance.
It’s clear that the American health care consumer desires chiropractic care. With a quality non-duplicated chiropractic service delivered at a reasonable fee that will allow health conscious individuals and families access to regular care, objective straight chiropractors are the individual health care providers of the 21st Century and beyond.
Remember the quote attributed to hockey maestro Wayne Gretsky? When asked why he has been so phenomenally successful, he replied, “Most players skate to where the puck is. I skate to where the puck is going to be.”
The public is waiting for us! They are clamoring for health and wellness; and they are willing to pay for it. Dr. Jack’s scenario may be where the puck was. Objective straight chiropractic is where the puck is going to be!s
Joseph P. Sasso, DC, is a 1983 Magna Cum Laude graduate of Sherman College of Straight Chiropractic and is currently in private practice in Toms River, New Jersey. Dr. Sasso served two terms as president of the Federation of Straight Chiropractors (FSCO), where he was called upon to travel extensively and address chiropractic students nationwide. Please call Dr. Sasso at 908-929-3322.