Over the past decade, the profession has moved away from a passive care paradigm and into an active care paradigm. When active care/rehab was first introduced to the chiropractic profession, it was in the form of an ancillary service. Rehab was the realm of entrepreneurial chiropractors who perceived rehab as an additional source of revenue to supplement the diminishing return generated by passive care physiotherapy. The 1990s saw a boom in the rehab equipment marketplace as chiropractors rushed to add high-tech resistance equipment, treadmills and ergometers to their practices. With reimbursement for active care codes between $40 and $60 per unit, active care produced an excellent return on investment.
Then came managed care and it became very challenging to recoup an investment of $10,000 to $20,000 in high-tech equipment. As low-cost, low-tech, turnkey tools came onto the market - tools that enable DCs to perform the active care procedures that third-party payers began to demand as a source of objective documentation of functional improvement - the perception of the profession changed from active care as a product to a paradigm.
A New Era
We have now entered a new era - the era of health care reform. Legislators and lobbyists are focusing on "prevention and wellness" as a method of decreasing out-of-control health care costs. A cover story in the business section of the March 16, 2009 issue of The New York Times highlighted the current health care reform crisis occurring in Massachusetts, the first state to implement universal health insurance for every citizen.
The costs to implement this bold project have doubled over the past year and the program will not be able to continue in its current form past 2010. Officials in Massachusetts have very clearly voiced their opinion that in order to control the major costs generated from managing chronic diseases, the state must focus its resources on programs and providers that efficiently deliver prevention and wellness services. Other states, if not our national government, will surely have all eyes focused on the events occurring in Massachusetts.
Objective documentation must be our standard for prevention and wellness services. The objective measurement that is the most widely accepted and referenced to determine a person's general state of "wellness" is body mass index (BMI).
According to this scale, an individual with a BMI of 25-29.9 is considered overweight. Approximately 66 percent of Americans fall into this category. Research shows that individuals with a BMI of 25-29.9 are more likely to suffer from diabetes, coronary heart disease, high blood cholesterol, stroke, hypertension, gallbladder disease, osteoarthritis, sleep apnea, and some forms of cancer (breast, colorectal, endometrial and kidney). An individual with a BMI of 30 or more is considered obese. To not measure and monitor this important index of health is to bury our professional heads in the sand of health care reform.
In order to position ourselves as the providers of preventative care for the significant causes of death and disease described above, we must make measurement of BMI on the first patient visit standard procedure in our practices. And as was done with active care, we must change the perception of weight loss from that of a product to that of a paradigm by providing low-cost (under $2,000), low-tech (BMI calculator spreadsheets, etc.), turnkey systems.
Chiropractors should begin to think of their patients' health using the analogy of a three-legged stool. The first leg of the stool is chiropractic care that maximizes the potential of the neuromusculoskeletal system. The second leg of the stool is the active care that empowers the patient and decreases their reliance upon passive care. The third leg of the stool is weight loss.
Weaken one leg and the stool teeters. Remove one leg and it comes crashing down. We cannot call ourselves practitioners of prevention and wellness without addressing the greatest measurable and controllable contributors to death and disease - poor diet and unhealthy lifestyle choices. We must become the true "whole-person practitioners" we claim to be.
The chiropractic profession can no longer focus solely on the musculoskeletal aspect of care. This places our profession firmly in the grip of third-party payers and in the vice of ever-decreasing insurance reimbursement. Embracing whole-person care that includes all three legs of the stool - chiropractic, active care, and weight loss/behavioral modification - will provide chiropractors with a solid foundation to withstand the winds of the health care reform storm and provide the profession with a central and unique role in the delivery of prevention and wellness. In so doing, we stand to make a significant impact on the health of our patients and our nation.
Dr. Mark Sanna, a 1987 graduate of New York Chiropractic College, is a member of the ACA Governor's Advisory Board and a member of the President's Circle of NYCC and Parker College of Chiropractic. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com).