As co-authors of Chiropractic Economics’ 1996 and 1997 Managed Care Surveys, we are pleased to share with you the survey results, as well as our comments, observations and opinions. In an effort to identify trends, we compared the following 1997 survey results to the 1996 results.
By Gerald R. Weis, DC By G. Steven Baer, DC
The information presented appears as follows: the survey question, then the choices, the respondents answers from 1997 survey, and finally our comments and comparison of results to the 1996 survey results.
1. Are you presently in a chiropractic or medical network such as an IPA, MSA, group without walls, etc.?
a) yes b) no
response a) 35% b) 65%
65% of chiropractic respondents do not belong to a physician organization IPA, MSA, etc. (question was not in 1996 survey).
2. What percentage of your practice will be managed care by the year 2000?
a) <25% b) 25-50%
c) 50-75% d) >75%
response a) 36% b) 30%
c) 23% d) 11%
66% of the respondents believe that less than 50% of their practice will be managed care by the year 2000 (54% in 1996 survey).
3. How dependent do you think the success of your practice will be on medical referrals by the year 2000?
a) <25% dependent b) 25-50% dependent c) 50-75% dependent
d) >75% dependent
response a) 62% b) 24%
c) 7% d) 7%
86% believe that their practice will be less than 50% dependent on medical referrals by the year 2000 (74% in 1996 survey).
4. If you had a choice under managed care, you would rather be considered a:
a) Primary Care Provider (PCP)
response a) 84% b) 16%
If given a choice, 84% would rather be considered a primary care provider (PCP) than a specialist, (SCP); (70% in 1996 survey).
5. How do you think the managed care system presently views chiropractors?
a) PCPs b) Specialists
response a) 8% b) 88%
88% agree that the managed care system presently views chiropractors as specialists (76% in 1996 survey).
6. How do you think the managed care system will view chiropractors by the year 2000?
a) PCPs b) Specialists
response a) 23% b) 75%
75% believe that the managed care system will view chiropractors as specialists in the year 2000 (60% in 1996 survey).
7. By the year 2000, experts predict the oversupply of specialists will be:
a) <25% b) 25-45%
c) 45-65% d) 65% or more
response a) 7% b) 31%
c) 32% d) 30%
93% of respondents agree that by the year 2000, there will be an over supply of SPCs ranging somewhere between 25% and 100% (74% in 1996 survey).
8. How knowledgeable do you consider yourself to be about managed care?
a) minimally b) moderately c) highly
response a) 36% b) 47% c) 17%
Knowledge about managed care: 17% felt highly knowledgeable (16% in 1996 survey); 47% felt moderately knowledgeable (45% in 1996 survey); 36% felt minimally knowledgeable (30% in 1996 survey).
9. How many seminars on managed care did you attend in the past year?
a) none b) one c) two or more
response a) 50% b) 29% c) 21%
50% did not attend a managed care seminar in the past year (41% in 1996 survey).
10. Would you consider taking a certification program in managed care?
a) yes b) no
response a) 81% b) 16%
52% would not attend a certification program in managed care (40% in 1996 survey).
11. Your present practice is:
a) solo b) group c) institutional
d) industrial e) multidiscpline
response a) 48% b) 29%
c) 1% d) 1% e) 20%
78% are in solo practice (41% in 1996 survey).
12. You view your future practice as:
a) solo b) group
d) industrial e) multidiscpline
response a) 51.5% b) 28.5%
c) .5% d) 1.5% e)18%
52% view their future practice as solo (51% in 1996 survey).
13. Do you feel clinically qualified to practice as a chiropractic specialist in a multi-discipline group?
a) yes b) no
response a) 94.5% b) 5.5%
95% felt clinically qualified to practice as a chiropractic specialist in a multi-discipline group (76% in 1996 survey).
14. Do you feel clinically qualified to practice as a PCP in a multi-discipline group?
a) yes b) no
response a) 81% b) 19%
81% feel qualified to practice as a PCP in a multi-discipline group (76% in 1996 survey).
15. Are you presently affiliated with a hospital?
a) yes b) no
response a) 6% b) 94%
6% are affiliated with a hospital (9% in 1996 survey).
16. Would you apply for hospital privileges if they were available?
a) yes b) no
response a) 60% b) 40%
60% would apply for hospital privileges if available (51% in 1996 survey).
17. You view managed care as:
a) a passing “fad” b) here to stay in one form or another
response a) 17.5% b) 82.5%
82% feel that managed care is not a passing fad, but here to stay (77% in 1996 survey).
18. You consider managed care to be:
a) an opportunity b) a problem c) both
response a) 7% b) 34% c) 59%
59% consider managed care to be both a problem and an opportunity (56% in 1996 survey).
19. Your practice income is
a) increasing b) decreasing c) staying the same
response a) 35% b) 37% c) 28%
Practice income: increasing 35% (26% in 1996 survey); decreasing 37% (40% in 1996 survey) staying the same 28% (25% in 1996 survey).
20. Do you think you can maintain your current level of income if you choose not to participate in managed care?
a) yes b) no
response a) 50% b) 50%
50% feel they can maintain their current level of income if they choose not to participate in managed care (41% in 1996 survey).
21. What effect has managed care had on the integration of chiropractic into mainstream health care?
a) positive b) negative c) no effect
response a) 23% b) 57% c) 20%
57% feel that managed care has had a negative effect on the integration of chiropractors into mainstream health care (question was not in 1996 survey).
22. What overall effect has managed care had on your practice?
a) positive b) negative c) no effect
response a) 11.5% b) 66%
66% believe that managed care has had a negative effect on their practice (question was not in 1996 survey).
23. Is a “cash practice” a viable alternative to managed care?
a) yes b) no
response a) 62% b) 38%
62% believe that a “cash practice” is a viable alternative to managed care (50% in 1996 survey).
24. What do you feel is the profession’s biggest challenge in managed care? (Please rank numerically in order of importance)
a. Properly identifying the role of chiropractors in managed care. (PCPs versus specialists)
b. Acceptance by the medical community.
c. Acceptance by the employer/ insurance community.
d. Teaching D.C.s how to access managed care programs.
e. Teaching D.C.s how to integrate with other disciplines.
f. Managed care education for chiropractic students.
response a) 26% b) 19% c) 31%
d) 5% e) 6% f) 3% g) 12%
Multiple choice: the majority of respondents feel that the profession’s biggest challenge in managed care is to gain acceptance by the employer/insurance communities.
25. What do you feel is your personal biggest challenge in managed care? (Please rank numerically in order of importance)
a. Properly identifying and then preparing for my role in managed care.
b. Understanding and accepting the managed care parameters of quality care, positive outcomes and utilization.
c. Structuring my physical plant, staff and practice systems to be compatible with managed care.
d. Affiliating with a group practice to become more attractive to managed care organizations and medical groups.
e. Accessing managed care programs.
f. Integrating with other disciplines
response a) 12% b) 19% c) 10%
d) 12% e) 28% f) 6% g) 13%
Multiple choice: the majority felt their personal biggest challenge was accessing managed care programs.
In tabulating the survey results, we were amazed at the almost 300% increase in respondents to the 1997 survey over the 1996 survey. We perceive this to be an indication of a marked increase in interest and/or concern by chiropractors about managed care.
As a result of our review of the survey results, we question whether the survey is just another example of chiropractors bucking the trend and defying the “experts.” Or are we dealing with a classic case of “mural-graphic-dyslexia” (failure to see the handwriting on the wall?)
Since 62% believe that a cash practice is a viable option, what happens if the “experts” are correct at predicting that 90% of patients, including Worker’s Compensation, P.I., Medicare and Medicaid, will be in managed care by the year 2000? That could leave 62% of chiropractors in a brutal price war fighting over 10% of the patients, with many of the patients being serious financial risks.
Particularly alarming was the fact that 88% of the respondents believe that the present managed care system views chiropractors as specialists and 93% of those same respondents agreed that by the year 2000, there will be an oversupply of specialists ranging from 25% to 100%. With chiropractic enrollment at an all-time high, it may well be time for more chiropractic institutions to reconsider their priorities and begin looking toward university affiliations and consolidating. It is definitely time to accept the fact that (agree or not) the marketplace (always the deciding factor) has already determined we are managed care specialists and the more effort we expend to enhance our value as NMS specialists, capable and willing to function in an integrated system, the more likely we are to be one of the specialist survivors.
We are not quite sure what to make of the fact that chiropractors are leaning toward solo practice, when there is a universal trend in all other health disciplines toward group practice for a multitude of reasons, including economies of scale, and becoming more attractive to managed care organizations. It is especially a good idea for current chiropractic students who are planning to practice in an area heavily penetrated with managed care to begin networking immediately with managed care friendly chiropractic groups in the area. Solo practice for a new practitioner with no track record is not a viable option in an area heavily saturated with managed care organizations that have already selected their provider networks.
Despite the fact that 82% of the respondents agreed that managed care is here to stay and their biggest personal challenge is accessing managed care organizations, 83% felt only minimally to moderately knowledgeable about managed care, 50% of the respondents have not taken any seminars on managed care in the past year, and 52% are not interested in taking a certification program in managed care. As a result of this apparent disinterest, we feel that the bulk of our profession is exponentially falling behind the managed care learning curve, and thus eliminating themselves from the current and future health system. It would seem that many of our colleagues still don’t “get” managed care and a large percentage are not even interested. Many feel that if they just bury their heads in the sand long enough, it will go away. You cannot gain acceptance by remaining ignorant about managed care and isolating yourself in solo practice. To play in the managed care “game” you need to learn the rules. You also need to group together and become integrated into mainstream health care.
As always, surveys not only provide answers, they also raise questions and interpretations vary because everyone’s perception is their own reality. As a result of the large response from the profession to the survey, and in an effort to monitor interest, attitudes and concerns about managed care, we will be conducting this survey on an annual basis.
We hope that sharing the survey results with the profession will help all of us prepare ourselves for the challenges and opportunities ahead.
Chiropractic Economics’ Managed Care Survey and follow-up commentary was developed by Gerald R. Weis, DC, President and G. Steven Baer, DC, Medical Director of Chiropractic Choice, Ltd, a physician organization of leading chiropractors in the Midwest. They lecture on managed care throughout the United States and serve as consultants for numerous managed care organizations, medical groups, hospitals, third party administrators and employer groups. Please contact them at 10671 McSwain Drive, Cincinnati, OH 45241; 513-563-4444; fax: 513-563-9540.
Chiropractic Economics’ 1997 Managed Care Survey questionnaire was originally published in the March/April 1997 edition. The 1996 Managed Care Survey questionnaire was published in the March/April 1996 edition, with results printed in the May/June, 1996 edition.
Survey Says… Mismanaged Care Comments from 1997 Respondents
What do you feel is your own personal biggest challenge in managed care?
Not giving in to fear of being excludedthe goals of mismanaged care and those of chiropractors are in contradiction!
Believing that it is the proper or principled thing to do.
Acceptance in HMO insurance plans. HMO companies only allow three chiropractors in my county.
Jersey City, NJ
Education of employers and insurance companies to the cost and benefits our profession provides.
Giving quality care is impossible.
Chiropractic needs to extricate itself from the medical community and practice healing as healers.
Being able to practice as a trained DC, internist.
Additional expense involved with middle man.
Morgan Hill, CA
Move to a cash practice.
Create a vision, develop a plan, work the plan, give more service than is expected, collect cash fee and watch the growth! Educate! Educate!
Miami Beach, FL
Bringing suit against managed care companies and MDs for not fully informing patients of treatment options.
Getting paid fairly for the work provided and being allowed to care for patients without hassles and being overburdened by paperwork.
Finding the best way to educate patients and others to the real value of chiropractic care.
Mountain Home, ID
Minnesota has been “closed” to out-of-network providers I couldn’t get in if I wanted to in any HMO and I tripled my business in ’96 without managed care! Richfield, MN
It’s more than time for insurance companies (HMOs, PPOs) to stop practicing medicine without a license! Managed care is medical treatment driven by economics only and not diagnosis or complaints.
Mt. Sterling, OH
Overhead costs, rent, etc., standard of living are we professionals or blue collar body mechanics?
San Fernando, CA
1. Our profession needs a national PR programall else will follow!
2. Unity for a stronger front! (ACA-ICA, etc.)
Just because we are neuromusculoskeletal specialists does not mean we can’t be portal-of-entry for those problems, even if we are not PCPs.
Every time I get a P.I. from my PCI or ACC group, we pay 8% back to them for what? So they can do paperworkI don’t like it a bit!
I don’t need or want managed care. If you provide the best chiropractic available, you’ll always grow in practice.
Cedar Rapids, IA
Managed care is a dead-end for chiropractors and will destroy more DCs.
You need to see volume in managed care, which is hard to do with so many different programs out there, it’s impossible to be a provider in a lot of them because their panels are closed. With IPAs, there are up-front fees. It’s hard to know which IPA gets managed care contracts more than another. Overhead increases and income decreases.
San Antonio, TX
Managed care will force any solo practitioners out of business. We are being forced to either form groups or cut overhead to a minimum.
Elk Grove, IL
Managed care is destroying personal quality health care in this country.
New City, NY
The original doctors that started managed care are now teaching patients to accept preventative and pay-as-you-go health care, ie, personal responsibility.
I’m 44% cash, 0% managed care. I chose to build a cash practice four years ago before the hit the fan.
We must stop emphasizing the need to “learn” about MCOs, guidelines, parameters, and new practice systems and “teach” insurance companies, MCOs and PCPs what we do and why it does fit in.
It is my hope that abuse of funds and poor quality of care in the managed care system will be exposed and eliminated.
Solo practices will always appeal to some people it’s more personalized and appealing to some.
Your survey is so far from reality. In Minnesota, managed care cuts everyone’s benefits. It doesn’t matter how well you understand it or document a patient. In #23 and #24, none of these matter. And quality here means four visits (means quantity).
Managed care only cheats the patient out of proper care. We need to be more concerned with care and not making tons of money.
PPOs are acceptable, but HMOs are bad for patients and doctors! Patients should have the differences explained to them!
San Antonio, TX
My plan is to get out of managed care and move towards cash.
No. 1 problem: there are no negotiations with MCOs. It’s “take it or leave it,” with reimbursement rates too low to make a living.
Bayonnet Point, FL
I see managed care as an opportunity to help millions of Americans that otherwise could not access care!
Service fees too low, too much paperwork, too much stress. I have been a cash practice for five years.
Managed care needs to realize the vital role that DCs supply in the country and the tremendous economic savings that we offer the US over standard allopathic care. Reneeville, IL
Do you think a national health plan would have served chiropractic better? Yes.
Deer Park, NY
Chiropractic is a way of life teach your patients and your practice group, people can afford to pay for health.
Santa Monica, CA
I would like to see managed care accepting newly graduated chiros. I myself am in almost every available HMO in this area.
Asking most MCOs to accept chiropractic is like asking Hitler to write a business plan for the Jewish community in Germany in the mid-thirties.
Managed care will kill most DC’s practices and incomes managed care for chiros stinks.
Palm Harbor, FL
A cash-based, high volume, low fee practice is my choice, rather than practicing “cookbook” chiropractic as a medic’s flunkie.
Managed care is a white collar protection racket. I want no part of itit is not good for PTs or physicians.
Cameron Park, CA
We need a level playing field federally mandated to include and delineate the role of the DC in today’s health care and extending into the 21st Century (it is currently not even an after thought).
Ft. Lauderdale, FL
I work in a rural low income area. 80% of my patients have no insurance. Managed care will not change that.
You should do a survey on steps we may take to enact political pressures, local and federal, to limit managed care.
Colorado is a bad state to survey. We have minimal worker’s comp., and auto is PPO with the majority in one PPO, which is closed.
I am staying out of managed care. I receive less than 10 referrals a year from MDs. The last HMO in this area usually gave two visits for a disc problem if the patient begged for chiropractic care!
Why don’t you do some articles on cash practices and forget the damn PPOs and HMOs.
The new DCs out of school are being deceived by our own chiropractic colleges regarding their future and destroying their dreams.
The two major HMO’s in my area have very limited and closed networks, preventing young DCs from entry.
Managed care cannot last in it’s current economic form. Economic law states that any relationship that is so heavily tilted to one side will have a short life span.
I’m just out of school, so any number of patients will increase my income.
I believe managed care is the ultimate public rip-offbig companies (PPOs) are getting rich while doctors and patients are getting “managed” away from their needs. Amery, WI
I view managed care as a back door approach to eliminating the chiropractic profession from health care in the U.S.
Santa Rosa, CA
It’s dangerous to let managed care define a profession for short-term gainright now what we need are specialists within MCOs only, leave it at that.
We (chiropractors) are our own biggest enemy when it comes to managed care and multi-disciplinary practices.
THANK YOU TO ALL WHO PARTICIPATED!
The results of this survey will be used in various studies and research projects. Due to space limitations, we regret that we were unable to print the comments from all of those who responded. Look for Chiropractic Economics’ next Managed Care Survey in the Spring of 1998.