Dynamic Chiropractic – August 16, 2004, Vol. 22, Issue 17

The Integrators

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
There is a new player in the health care arena known as an "Integrator." They are having a profound effect on your practice and you probably don't even know it.
  • How are they limiting your practice?
  • Who are they?
  • What can you do about it?

How Are They Limiting Your Practice?

Integrators have almost absolute authority.

They base their decisions on multiple criteria, some objective and some subjective. They are very sensitive to public opinion. All of the pro-chiropractic data in the world may not be able to convince an Integrator to overturn their decision once they make it.

Integrators determine patient access and reimbursement rates by "valuing" your practice. They actually formulate a value for your services, based upon a visit to your office. They are authorized to place a different value on the same service from two different DCs. Depending on their findings, they can facilitate access to one chiropractor's office while limiting access to another's.

Not all Integrators have the same criteria for their reviews. Most have similar review criteria, but many do not. They are not required to conform to any current standard.

Who Are They?

Integrators decide what you will and won't do in your practice. They have authority that transcends patient access and reimbursement rates. If an Integrator decides that you can only provide back pain relief, that's all you will be able to provide. An Integrator could even decide that you are not the appropriate provider at all - even for something that is part of chiropractic's core competency!

Integrators are your patients.

Whether you realize it or not, your patients are integrating chiropractic care with medical care, prescription drugs, vitamins, over-the-counter (OTC) drugs, other forms of alternative care, and stuff their mothers told them to do whenever they got sick. As one recent survey clearly pointed out, only 4.4% of patients are "relying primarily" on any particular form of alternative care.1 This means that 95% of your patients are very comfortable "mixing" their chiropractic care with a host of other therapies and remedies.

In fact, a very recent study revealed that 52.9% of chiropractic patients decided to use chiropractic care in the first place because they believed that chiropractic "combined with conventional medical treatments would help."2

Think about it. More than half of your patients have sought your care with the preconceived intention of combining the benefits of chiropractic care with their existing medical care.

What Can You Do About It?

Realizing that you/chiropractic are one of a number of providers/remedies that your patients use to maintain their health should help define the way you see your practice. You are competing with other forms of care. Your care is being graded according to the following criteria:

  1. How effective is it?
  2. How fast does it work?
  3. How much does it cost?
  4. How easy is it to do?

Every time a patient has a complaint, they will compare your ability to address that complaint with their other choices. If you are more effective (provide longer or more complete relief), provide relief quickly, and cost about the same as another provider, you will be chosen to address that complaint. If not, you won't.

And while educating your patients about the value of chiropractic is very important, if your care doesn't measure up to the alternatives, patients will make other choices.

Chiropractic care as a way of life has been extremely beneficial to me for almost 50 years. I can almost count on one hand the number of times I've seen an MD during my adult life (outside of military service).

But today's health care consumers are armed with too much information to just sit back and allow choices to be made for them. They want what they believe to be the best choices, based upon the information at hand and their personal experiences. To be successful with each patient, DCs need to inform them about all of the benefits of chiropractic care and then deliver on those promises in the most effective, efficient and economical manner possible.


  1. Astin JA. Why patient use alternative medicine: results of a national study. JAMA, May 29, 1998; 279(19):1548-53.
  2. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data 343. May 27, 2004


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