Dynamic Chiropractic – May 10, 1991, Vol. 09, Issue 10

New Mexico's Leading HMO to Open Chiropractic Facility

70% of Residents' Polled in Favor of Chiropractic Care

By Steve Kelly, managing editor
If "love is never having to say your sorry," then Lovelace is never having to say chiropractic care isn't available. What is Lovelace? It is a hospital, 12 satellite patient care facilities, a 120,000 member HMO, a multispecialty physician group practice, and is in affiliation with a medical research institute.
Lovelace is New Mexico's leading "integrated" health care organization.

Lovelace will open its first chiropractic office on June 24, 1991. The facility will be located in Albuquerque and will be called Lovelace Chiropractic. Lovelace Chiropractic will be the newest addition to the multidisciplinary approach of the Lovelace Division of Occupational Medicine. Lovelace Chiropractic will be available to the public, regardless of an individual's insurance plan. Lovelace physicians will be able to refer patients to Lovelace Chiropractic for neuromusculoskeletal disorders.

Lovelace recognizes chiropractic as a healing art which treats people through non-invasive procedures. In New Mexico, one-hundred percent of chiropractic coverage is provided for workers' compensation and auto injuries.

"Although it is unique to have a chiropractor as part of a physician group practice such as Lovelace, we have chosen to do so because of the needs of our patients and clients," states Edward Sweetser, M.D., vice president and chief medical officer of Lovelace. Dr. Sweetser added, "Lovelace acknowledges that chiropractic is a recognized form of alternative health care. We want to ensure that each patient receives the best care possible for their health problems, and in some cases, it may be a chiropractor who helps to provide that care."

Gaining Access to Lovelace

Fifteen years ago, a surgical nurse at Lovelace suggested to James Lehman, D.C. that he meet Dr. Sweetser, then an orthopedic surgeon at Lovelace. The two men discussed working together, and developed a referral relationship that grew over the years. In 1985 Dr. Lehman met with Dr. Sweetser and Dr. Samuel Barol M.D., medical director of the Lovelace HMO. They discussed providing chiropractic services through the HMO. Due to the efforts and persistence of Dr. Lehman and the support of MDs Sweetser and Barol, the referral system became a reality. For the past six years Dr. Lehman has been getting referral business from the Lovelace HMO to his private practice.

Dr. Lehman had suggested to Dr. Sweetser as early as 1984 that it would be beneficial for chiropractors to work at Lovelace. Meanwhile Dr. Sweetser progressed to chief medical director at Lovelace and was able to introduce the idea of chiropractors working at Lovelace to Dr. Derick Pasternak, president of the board of directors. The senior management along with Duke Rodriguez, chief operating officer, requested that a complete proposal be developed, including a cost benefit analysis, quality assurance guidelines, productivity standards, and a general explanation of what chiropractic would provide. This report was reviewed and modified and then presented to the board of governors (a panel of 7 MDs elected by the staff). The board of governors voted to approve chiropractors as part of the Lovelace staff.

The positive decision of the board was largely a result of a survey taken of Albuquerque residents commissioned by Lovelace. Seventy percent of those polled were in favor of chiropractic services being offered at Lovelace. As Dr. Sweetser said: "We pride ourselves at Lovelace at being a customer driven organization." Clearly the board of governors believed that chiropractors on staff would improve the quality of care offered by Lovelace and increase profitability.

Dr. Lehman has invested 12 years towards this goal, laying the groundwork, and putting forth the effort to make it happen. When the initial HMO panel of DCs was being set-up, Dr. Lehman relates that the majority of DCs didn't want to participate. "The DCs didn't want to do the necessary paperwork and follow the protocals to fit into the program." Dr. Lehman states candidly, "DCs need to get their act together on that issue as managed care is going to provide most of the health care in this country. Chiropractors need to open their eyes and realize they need to be part of the system."

Working with Dr. Lehman at Lovelace Chiropractic will be Robert Duchesne, D.C. In 1990 Dr. Duchesne was director of the Community Health Center for Logan College of Chiropractic in St. Louis. Dr. Lehman was acting as a consultant for Logan and the two men discussed the subject of Lovelace. Dr. Duchesne felt Lovelace represented the facility of the future, but was very involved with the center. Dr. Duchesne left Logan to open a private practice in Utica, New York, but in January of 1991 joined Dr. Lehman at Lovelace. Drs. Lehman and Duchesne signed one-year contracts with Lovelace with renewal options, and are presently the only two chiropractors who will provide chiropractic care at Lovelace. Dr. Lehman foresees at least five five more clinics in Alberquerque, and then other chiropractic services throughout the state." Dr. Lehman notes that among HMOs, Lovelace and Puget Sound in Washington state have the best chiropractic services available. Dr. Lehman explained that many HMOs that offer chiropractic care allow only three visits per condition. At Lovelace the DCs may treat a patient's condition up to six months if necessary. Reports are submitted to validate extended care, but Dr. Lehman acknowledges that Lovelace is very flexible in this regard and that he's never been accused of overtreating.

Dr. Lehman expressed there are more limitations for the chiropractor working with medical institutions and hospitals than in private practice. "We do not provide everything that we could through our scope of license. We concentrate on neuromusculoskeletal conditions." Treatment limitations were negotiated back and forth, but no limitations have been mandated by the hospital. The DCs can order any diagnostic test they feel appropriate.

Dr. Lehman explained that when working in the hospital setting it is standard procedure to refer to the specialist. As an example Drs. Lehman and Duchesne could offer patients counseling in nutrition, but as there are nutritionists on staff who are specialist, Dr. Lehman feels it's more appropriate to refer a patient to them rather than try to dilute the chiropractor's effectiveness in an area that is not their domain of greatest expertise. Dr. Lehman makes this point by noting that he is a board eligible chiropractic orthopedist and can do casting, but says: "Why should I (do casting) when I have 35 orthopedic surgeons available to refer to? What I get to do is concentrate on what I'm best at -- dealing with patients that have spinal problems that need chiropractic care."

In the development of the business plan/proposal from the senior administration and board of governors, one of the tasks was a ten step quality assurance plan. "It was one of the most exciting things I've ever done as a chiropractor," Dr. Lehman enthused. The accrediting body for hospitals mandates that every hospital have quality assurance plans. Dr. Lehman feels that the quality assurance plan developed at Lovelace is the answer to the search for chiropractic standards of care. Dr. Lehman has shared with Logan College Clinic this quality assurance plan which Logan has already used as a guideline in developing their own plan. "It's something that every chiropractor and every chiropractic college clinic can start doing to prepare this very vital need for standards of care in chiropractic," said Dr. Lehman.

Dr. Lehman encourages DCs to take seminars on hospital privileges and protocols and start developing relationships with medical institutions, especially with HMOs and PPOs.

Dr. Lehman places responsibility for the success of chiropractic on initiative within the profession: "I think the future of chiropractic is in the hands of the chiropractors, if they are willing to make the extra efforts to make their services more available to the public ... we're going to keep growing and being more prosperous."

Steve Kelly
Assistant Editor


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