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Dynamic Chiropractic – November 20, 1995, Vol. 13, Issue 24

Warfare Requires New Directions

By Stephen R. Seater
"Chiropractic is at war," said Mark Goodin, legislative strategist for the ACA. Mark was right on target when he made that statement. Chiropractic's market share is shrinking with the managed care juggernaut, coupled with medical prejudices. The enormous growth of managed care however is the principal reason practice incomes are down over most of this country.

On an average day, the FCER staff talks to about 50 practicing chiropractors. These doctors are telling us more and more frequently that their practices are down, some by as much as 50 percent! And time and time again, the villain is managed care. In areas where managed care is growing rapidly, it is systematically cutting out most chiropractors.

Surveys confirm this impression. The ACA's 1994 annual survey shows a dramatic drop in the number of new patients per week over the last 10 years. Furthermore, gross and net incomes are down from the same period. And a recent survey of FCER trustees revealed that every DC who serves on our board has seen their practice income decrease in the last few years.

Because chiropractic truly is at war, FCER has spent considerable time updating its strategic plan so that we can better meet the needs of the profession. We surveyed our trustees, members, donors, and buyers and pooled the results with what we already know about the current health care market. The result was that for the first time in our 51 year history, FCER has prioritized the kinds of research to be funded. And with a few exceptions, we are talking about very practical, real world kinds of things that are designed to help the profession deal with the many challenges facing it.

FCER's number one priority is clinical research, with the emphasis being placed on randomized, controlled, clinical trials. Of course, we are also interested in case studies and other types of clinical research that could lead to the funding of trials at a later date. It was the strength of clinical trials research that secured your profession's place in the AHCPR guidelines on acute low back problems, the British guidelines, and the Manga Report. Closely related to the above kinds of research are practice-based studies, such as the one being carried out in Oregon by Dr. Joanne Nyiendo. FCER maintains a keen interest in this kind of research and will most likely fund more.

High priority has also been given to patient satisfaction studies. In a market driven health care system, the results of patient satisfaction and utilization studies have taken on great significance in decision making. Some experts have said that patient satisfaction may be more important in the overall scheme of things than outcomes research. Patient satisfaction studies of chiropractic patients demonstrate that they are overwhelmingly satisfied with the quality and effectiveness of their care. Additional studies are needed to produce more specific information.

The escalating cost of occupational low back injuries reflects a growing legal, health care, and economic crisis in the United States. Estimates of the total annual loss due to back pain alone in the US ranges from $20 to $50 billion, when lost productivity is taken into consideration. While patient care will always be first in the minds of doctors of chiropractic, we must be able to defend the cost-effectiveness of chiropractic with well designed, compelling economic studies in managing a variety of conditions when we go to the managed care bargaining table.

Lastly, many large managed care companies exclude or severely limit access to chiropractic care, prompting Groups of chiropractors and their patients to file suit against these health care monopolies. Everything from antitrust laws to such legal principles as informed consent should be researched. FCER will assist in this area whenever possible and appropriate by funding such research.

The survival of chiropractic rests on a three legged stool. Research is but one of those legs. And although research has helped chiropractic via the Manga Report, and the AHCPR and British guidelines, such achievements will accomplish little by themselves. FCER believes that research findings must be used to further the profession's legislative, legal, and public awareness agenda. This is the only way that patients can be guaranteed their right to obtain chiropractic care. Just as the profession had to fight for insurance equality, it will have to fight for inclusion in managed care. Ultimately, it is political action that will win the battle.

No one understands the need for political action better than health economist Pran Manga, PhD, who said: "You don't win an argument on paper, or in books or monographs -- even the type that we've written. Ultimately, you have to make a battle of it, and political reform doesn't come easily. Ultimately, you win or lose this battle in a political arena and not because you have very convincing studies and an eminent health economist says it should be done this way."

Political action buttressed by research findings is what will win the day for chiropractic. The more practical the research, the greater the likelihood chiropractic can win provided it has the will to fight and fight hard. FCER intends to be part of a winning strategy that uses research to win the war Mark Goodin spoke of.

For more information, contact the FCER at 1-800-637-6244.

Stephen Seater, CAE
FCER Executive Director
Arlington, Virginia

Click here for more information about Stephen R. Seater.

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