Some doctors of chiropractic have penetrated managed care organizations (MCOs) and are doing well, but the usual pattern is for the DC who is included in an MCO to experience very low utilization. A case in point is a good friend of mine who practices in the Washington, DC suburbs and who is listed as one of the chiropractors within the Kaiser Permanente HMO, but has never had a single patient referred to him. Recent research funded by FCER suggests that MCO utilization of chiropractic care is not likely to change significantly due to the monopoly MDs have in these plans.
A frequently asked question is, "What about the AHCPR guidelines?" These guidelines help to some extent since many people, but certainly not all, equate spinal manipulation with chiropractic care. Unfortunately, however, the term spinal manipulation is generic and DOs, some MDs, and some PTs claim that they can perform such services. In fact, PTs are hard at work learning how to perform spinal manipulation and are sometimes aided by renegade chiropractors in learning this art. But beyond this fact, some recent research has revealed that medical gatekeepers are very skeptical about any research or cost effectiveness studies showing chiropractic care to be superior to standard medical treatment of musculoskeletal injuries. In my opinion, it is not the amount of outcomes data that matters as much as getting the MCOs and their medical personnel to accept it as valid. Moreover, few allopathic gatekeepers know anything at all about chiropractic and quite naturally prefer to send patients to other members of the medical fraternity with whom they are familiar.
Robert Maust of Research Dimensions, Inc. (RDI) believes that "the key to minimizing the effects of MD barriers to chiropractic utilization is demand and the key to demand is the employer-payer." Since most Americans receive their health care coverage through their employers, the primary target of chiropractic information campaigns should be the employer-payers and their employees, and not the MCO or MD gatekeeper. The latter are secondary targets and should not be abandoned, but the greatest effort should be expended on employer-payers and grassroots public information programs.
Reading on in the market report of "U.S. Chiropractic Services," I was amazed to see its authors state that "to succeed, chiropractors must change the public's perception as the 'back and neck profession,' embracing a wellness/prevention, whole body care position." It is almost as if they had read "Chiropractic: A Primary Care Gatekeeper," by Arnold Cianciulli, DC, MS, which to my knowledge they have not. They go on to say that chiropractic needs "to return to its original vision as a preventive, non-drug, nonsurgical, holistic primary care profession." They recommend this for the same reason I have been advocating it for years. "'Holistic' medicine has been gaining credibility among consumers, physicians, and insurers alike. Insurance companies and employers especially are trying to contain spiraling medical costs via such lower-cost methods as chiropractic (versus surgery, drug treatments, etc.)."
The window of opportunity is open for chiropractic to capture a greater market share. However, this opportunity will be lost without the right kind of positioning strategy. Simply contributing more dollars to more of the same kind of public relations, we have seen over the last few years will not work.
Stephen R. Seater, MA, CAE
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