The Managed Care Vision for Chiropractic

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“Managed Care” has a vision for chiropractic.  The following is a letter received from an HMO soliciting participation by chiropractors in their program:

    “Dear Doctor,

               As one of the largest HMOs in the country, ___________ is in a position to offer you, the doctor of chiropractic, a very prominent position in our organization as a primary health care provider (PHCP).  As you probably know, the purpose of HMOs is to deliver quality health care while keeping costs as low as possible.  With this goal in mind, we have determined that the PHCP’s major responsibility is to prevent needless medical care by screening out those who do not need care.  We believe that in the chiropractic field you, as a PHCP, can help us to achieve that objective.  In the field of medicine, the medical PHCP provider is reimbursed for patients who do not need to be referred or see a specialist while under their care.  Since chiropractors do most of their own treating, we have developed a unique system to serve the chiropractic patient.  This idea is not unique, the federal government has been doing it for years.  We will reimburse you the PHCP on a per patient basis for each visit a patient does not have to make to your office.

                   Here is how the program works:  When one of the participants in our HMO comes into your office as a patient, you will begin to receive up to $30.00 per visit per patient with a maximum of 12 visits per year (Federal Guidelines) for each time you do not see the patient.  Each time the patient is seen during the course of the year, your fee (up to $30.00) will be deducted from your annual emolument.  As you can see our health maintenance concept pays you to keep your patients from needless care.

                   As an example, should you have 500 _______ members sign with you and see none of them during the course of a year, you would be paid a maximum of $180,000 per year (500 patients x 12 visits x $30.00/visit).  Of course that sum would be reduced by $30.00 each time the HMO member visited your office for care.

                   We are most eager to hear from you concerning participation in this program.  Please contact Mr. _____ for more details and an application

         at . . .”

          Okay, I made that letter up but think about it.  If chiropractors were paid not to schedule patients, how many of them would do it?  If a chiropractor could be paid $180,000. a year to not see 500 people, how many of the 500 would get regular chiropractic care or any care for that matter?  If managed care organizations get hold of this idea, they will jump on it. The HMO member would have chiropractic “coverage” for which the HMO can charge them or their employer but the HMO would be assured that whatever participating chiropractor the member went to, they would never pay more than $360 a year for that person’s chiropractic care.  Many compare this to the fact that chiropractors get more than $360 out of a patient’s insurance company during the first month of their care.  The chiropractor would be happy because he gets his money without any effort.  The HMO would be happy because they significantly reduce their expenses.  And the patient, if he does not know any better, thinks he is getting a deal as well.

          Actually, I think the system would be great.  Eventually the patient wanting care, would be forced to go to a non-participating doctor (me) and pay out of their own pocket.  As for the greedy chiropractor who has no desire to see people receive chiropractic care but only wants to make money, if we cannot get him out of the profession, the next best thing is to have somebody pay him to not see anybody.v13n2

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