A Whole New World -- Or Is It?

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
What's with the cover? Is this the same Dynamic Chiropractic I read last issue? Why all the changes?

Some things are obvious, others are not. You couldn't help but notice our new mast head. It is printed on "astrobrite," a brighter, whiter paper that allows better four-color expression and is easier on the eyes.

Take a look at page 5. Our expanded index will allow you to scan every article by each of our columnists. In fact, the new format is designed to tell you what's in each issue with a quick read.

As we begin our second century, chiropractic requires a publication that is more responsible to you the reader. You need to know the important things that are happening as soon as possible. How can you make decisions without reliable, un-biased information?

Your time is precious. Why sift your way through several different publications trying to find out what's happening? Most of the chiropractic profession relies on us as their news source. This is a heavy responsibility that will always force us to grow and improve as the world changes.

The same is true for the chiropractic profession!

It's seems rather fitting, that we begin our new format as we begin our centennial year. We also begin this year with federal guidelines that recommend manipulation over surgery for acute low back problems.

The health care world is changing rapidly, and the guidelines for acute low back problems by the Agency for Health Care Policy and Research (AHCPR) are going to have a major impact on chiropractic. Your practice can enjoy substantial benefits from the AHCPR guidelines.

What do the guidelines say? Besides the obvious clinical recommendations, these guidelines make six statements that should be well considered:

The Value of the Adjustment -- While the guidelines don't express the full value of an adjustment (manipulation), they do recommend it. Imagine, a federal panel suggesting chiropractic ahead of surgery.

Return to Your Roots -- Many may lament that surface EMG, thermography, acupuncture and physical modalities were not recommended by the guidelines. But they sent a very clear message to the chiropractic profession: "Go back to the adjustment as your basis of treatment!"

Research or Perish -- The message to the equipment manufacturers is also clear: "If you don't have sound, objective, high quality research to support the use of a device, it will probably fall into the not recommended category. The same can be said for all forms of treatment and diagnosis. Only good science can protect viable therapies.

Physical Therapist Have Almost No Place in Acute Low Back -- Look over what is and isn't recommended, with the exception of exercise, there is almost nothing that applies to physical therapists. In fact, the PTs did not even have a representative at the press conference in Washington DC. They are completely unrecognized by these guidelines.

Try Everything Else Before Surgery -- The risks and failures of back surgery are well known. The surgeons are not happy with the guidelines, but they knew this was coming. While there is a place for some spine surgery, the best advice one could give an orthopedic surgeon would be to develop working relationships with a few hundred DCs for those rare cases that require referral.

More Guidelines Are Coming -- Not only will these guidelines greatly affect your practice, but there are more coming. This is the beginning of your "whole new world".

Currently managed care organizations are scrutinizing every pill, procedure and piece of equipment; each must prove itself. Everything you do in your office is also being evaluated. Yes, there may be managed care plans that cover unproven therapies, but they will be _very_ _expensive_. More than likely, patients will pay for uncovered benefits out of their own pockets.

The AHCPR guidelines affect all health care providers treating acute low back problems in adults. While they are rather specific in scope, the recommendations will tend to be generalized by government agencies and insurance companies. These guidelines offer significant malpractice protection. The courts will have to sort out just how much.

Take a good look at your practice. These guidelines encourage manipulation and discourage expensive diagnostic equipment, modalities, and surgery. High touch, low tech, low cost is the order of the day.

Isn't that what we've been saying for the last hundred years?

Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.

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