Primary Spine Care
A mandatory “future trend” for chiropractic success that has already begun
By Mark Studin
William J. Owens
Primary Spine Care has been proven in the market place as chiropractic’s future and the instrument to increase our utilization. Primary Spine Care simply means that the chiropractor is the first referral option for mechanical spine issues short of fracture, tumor or infection. After 10 years of development and 4 years of market testing, this paradigm has been released nationally and has far exceeded our expectations based upon the dramatic increased utilization of chiropractic services nationwide from private practice to hospitals. If you are committed to being “the best-of-the-best” through clinical excellence, you can still create a leadership position in your community for both you and your practice with not losing sight that this is happening, with you or without you, and if you are not out in front you will potentially be forever behind.
Insurers are scrambling to “corner the market” using the lure of primary spine care. In the end, this is just another plan to further limit your reimbursements; it is “managed care in sheep’s clothing”. Hospitals are also devising primary spine care schemes to dupe you into becoming one of their devoted “minions” into a 1-way referral pattern; with you referring into THIER system while avoiding referring into YOURS. Chiropractic academia is also struggling to catch the primary spine care trend, while their true mandate is to prepare our future doctors of chiropractic to pass national and state boards. Our politicians and political organizations have realized they are also significantly behind this trend and are reaching “inward” in a hope for someone within the organization to try to take a leadership position. Although our political organizations are vocally touting their ability to grow chiropractic, we can see historically the opposite is true. Our profession has thought leading with politics was the answer and that path would finally deliver chiropractic into the mainstream, however, based upon published evidence, that approach has proven to deliver relatively stagnant growth as reported by Adams et. Al (2017). Adams states chiropractic utilization to be 8.4% of the population. It was also reported that 35.2% of the United States population takes over the counter drugs and 23.2% takes prescription medications for the same conditions that respond favorably to chiropractic care. The disparity in utilization of drugs vs. chiropractic care underscores that our global approach to the promotion of chiropractic care is failing, and it can no longer be “business as usual.”
One of the fastest growing trends in healthcare today, is defining who should be considered a “Primary Spine Care Practitioner.” There is a myriad of factors to consider and the timing, based upon a “Best Practice/Evidence Based Models” (consisting of the scientific literature, patient feedback/expectations and the doctors experience) is perfect for chiropractic to take its place as the leading profession in this critically important niche. As a society, we are failing to provide adequate spine care. One of the issues that inevitably occurs when there is a trend catching everyone’s attention, is the rise of the “fly by night, get rich quick, self-proclaimed gurus” that cut corners behind the scenes, but gives you the perception that they are true leaders. Our profession has a significant history of this occurring, particularly in the managed care arena and we are seeing it starting to happen within the contemporary Primary Spine Care Practitioner trend. We wanted to provide insight on what is occurring from our unique position, which combines both chiropractic and medical academia and clinical practice. We would like to outline the critical factors to consider so you can prepare to effectively participate and leverage this important trend in healthcare to your private practice. The end result; increase utilization (you are busier).
The following should be considered a guide to your path to success in Primary Spine Care and WHO to participate WITH and WHO to AVOID.
TRACK RECORD OF SUCCESS
One of the most important aspects of evaluating a Primary Spine Care training program, or even taking advice at the academic, political or consulting end is determining whether the program and its instructors are coming from a position of success. Do they present with a proven track record or are they are simply capturing a trend and experimenting with you and your practice? Consider the reality television show The Shark Tank, a show which has billionaire investors investigating companies that want them to invest in their products or services. The Sharks have a simple rule, which is an underlying theme of the show, what has the “wannabe” business PRODUCED in revenue or success PRIOR to a Shark considering investing their personal money? If the answer is little or none, then the Shark passes since speculation rarely leads to profit. Too many Primary Spine Care “guru’s” promote a pathway to success, but have not achieved any significant level of expertise or track record in filling offices in a profitable scenario. These are the groups that have so called “friends” on the inside and at first glance seems impressive, but as you dig deeper into their past successes they come up empty. It is important to not enter a training program that needs YOU to grow, that is a recipe for failure, frustration and no return on your investment. We suggest asking how many chiropractors are currently in the program and how may referrals they have to date in their system [most do not keep track for obvious reasons] and GET references. Facts are facts and not rhetoric and no matter how “sexy” a program appears, it means nothing if it doesn’t work. This is the difference between an experimental process and a real program achieving real results. Don’t be the experiment.
Secondly, we want to caution you to make sure every Primary Spine Care program is putting chiropractic first. We suggest asking if the program is chiropractic centric or does it concurrently invite physical therapists as Co-Primary Spine Care Providers? It has long been discussed and demonstrated [CLICK HERE FOR VERIFICATION] that the scientific literature has concluded that chiropractic care for spine is superior to that of physical therapy at many levels including pain management and in the reduction of recurrent disability.
Blanchette, Rivard, Dionne, Hogg-Johnson and Steenstra (2017) reported:
The type of first healthcare provider was a significant predictor of the duration of the first episode of compensation only during the first 5 months of compensation. When compared with medical doctors, chiropractors were associated with shorter durations of compensation and physiotherapists with longer ones. Physiotherapists were also associated with higher odds of a second episode of financial compensation. These differences raise concerns regarding the useof physiotherapists as gatekeepers for the worker’s compensation system. (pg. 388)
Programs that include physical therapy are brining chiropractic down to a level that will not ensure your success as the outcomes are far less effective than a chiropractic spinal adjustment as evidenced in the paragraph above. Physical therapy has its place in spine care, but not first. It is our experience that a program who offers both chiropractic and physical therapy as primary spine care will do this to ensure the profit of the program and NOT YOU. We also firmly believe this creates a public healthcare risk by supporting poorer outcomes, which feed the current opiate epidemic by mismanaging mechanical spine patients. In the end, this will create a perception that chiropractic and physical therapy are equal. Nothing could be farther from the truth and nothing could be more dangerous to the public and your long-term success. Only consider a Primary Spine Care program that is chiropractic only.
MANAGED CARE IN DISGUISE
This is one of the most negative aspects of the current Primary Spine Care trend and one that we see happening more and more each week. There are groups in our profession that are promoting the Primary Spine Care concept not to help chiropractic, but to “sell” chiropractic to insurance carriers or hospitals under the umbrella of third party administrators or managed care. This type of focus is NOT in the best interest of chiropractic and does not have your practice’s best interests in mind or the chiropractic profession (for verification, see all the current managed care models that allow 8 or 10 visits at a severely reduced fee, where most have chiropractors controlling your practice and paycheck). Insurance carriers are not ignorant, they realize the benefits of using chiropractic care and coverage is expanding in these plans, however there are those in our profession that continue to insert themselves between hardworking chiropractors and the insurance carriers. This is a veiled attempt to create a “network” of doctors that they can sell to the highest bidder. These “middle men” even promise doctors in their group a steady stream of patients, but in the end, it is an empty promise or worse… you get a lot of patients at such a reduced rate that paying your bills is challenging. Don’t let this happen to you and your practice. Enriching others at the expense of your practice and your family is not a recipe for success. We suggest reviewing ALL the directors of ALL programs you are considering and if there is ANY indication that they had consulted with insurance carriers, worked for managed care companies or are significant players in the independent examination world…RUN. Many are now getting astute and realizing that chiropractors have been taken advantage of for too long, so they leave these things off their CV or Resume. We suggest searching GOOGLE and Social Media, many have digital trail and an employment track record that can be uncovered. This is occurring faster and more obviously than previously thought…don’t be taken advantage of, consider WHY the program was created and to whom the money flows.
One of the more “sexy” portions of working as a Primary Spine Care Provider is the hospital component. Since doctors of chiropractic have historically worked outside of the mainstream health system, it continues to be relatively rare for DCs to be included in hospital groups. Fortunately, hospitals are working with doctors of chiropractic more than ever before, however many of the chiropractors that are leading the way are simply being taken advantage of by the system. Most chiropractors don’t know it is occurring, while hospitals are “selling” YOU on perceived success in breaking into their system. In the end, it is just a house of cards and will do nothing to move you or your practice forward. When working with the hospitals as a Primary Spine Care Provider, the point is that THEY REFER TO YOU as the first option for mechanical spine issues. If the hospital is excited to receive referrals FROM you instead of referring TO you…RUN. Hospitals not referring to chiropractic as a first choice for spine is NOT a Primary Spine Care Program, it is an enrichment program for the hospital and the consultant that is promoting or selling the program. Caveat Emptor!!! Do your homework first and do not fall into the trap of being put on a list, having access to doctors in the hospital and having an open line of communication with doctors you refer to… you already have that! A true Primary Spine Care Program ALREADY has established, or will give you the pathway for referrals INTO YOUR office. Anything other than that is to suck you into the hospital system to get your referrals. Never lose sight that chiropractic is big business for many hospitals and they will do anything to get your business and not give an inch to allow you a piece of theirs. The tide is turning with many hospitals bringing chiropractic on staff, changing by-laws to create chiropractic inclusion into their system and realizing that the best business model is the chiropractor as the first referral option and keep everything else in-house. Make sure you are creating or entering the right system, a REAL Primary Spine Care Program will teach you that and show you how it has been done in other areas of the country.
ACADEMIC AND CLINCIAL BASIS
In the chiropractic world, there are two places that a program can evolve FROM and two places that it is governed BY. The program can evolve FROM either an Academic or a Clinical perspective and it can be governed BY either Academics or Politics. These are very important points to consider. First, when a program is buried in Academics, although it may be perceived as having state of the art information, it is often built and run from predominantly a theoretical perspective. This is a prime example of a “it looks good on paper” program, which has not had any real measure of clinical success in the marketplace. Secondly, when a program is developed and run by clinicians there is often a narrow-sited approach that is missing what the literature provides and not understanding the trends in the industry. Many times, the clinicians are lacking significant post-graduate training on MRI, Spinal Biomechanical Engineering and triage protocols which ultimately will make the program ineffective or focus on one aspect too heavily. This is at the expense and ultimately the success of your practice. Another alarming trend is when politics drives the process. It is our observation over the last 4 decades that politics typically drives patients and income to those who are in control of the political process and their “friends.” Typically, the rest of the profession, no matter how hard they try, work or get better, simply can’t participate as the system has been designed for so few. In addition, politics in our profession has been controlling too much and has crossed the lines too often in our academic process; they should support academia, not lead it . The “politics first” approach has lead us to an 8.4% utilization in the United States when failing spine care is epidemic nationally and with so many patients suffering, all chiropractic offices should be on a waiting list.
When we consider how a program is governed, the options are either academia or politics and as stated above, politics should support academia, not drive it and the success of a Primary Spine Care program is a perfect example. Politics cannot drive it, there must be a mix of significant post-doctoral (graduate level) formal training and a long history of success in this paradigm.
It can no longer be business as usual, your success and future depend on it.
The perfect solution is a blend of meaningful post-doctoral (graduate level) formal training and clinical practice with a track record of success. Politics as previously stated is there to support the process, not drive the process. Historically the old way of doing things is not working based upon the 8.4% of our current utilization. Investigate the qualifications and experience of who you are listening to and who you choose to follow, and a blend of academia and successful clinical experiences is the perfect solution. This can be verified by demanding to inspect the Curriculum Vitae of all involved and then scour both Google and social media as previously suggested.
After 10 years of researching the infrastructure of primary spine care and 4 years of market testing in figuring out HOW to make it work in every chiropractic office in the world, we have ALREADY gotten 711,434 (as of 1-26-2018) referrals INTO chiropractic practices in 47 states from lawyers, primary care medical providers, medical specialists, urgent care centers and emergency room. I also want to report, that this number is an approximate, where the actual number is significantly higher, but that is all we can safely verify. It is this number that would make the “Sharks” happy because it already works, and YOU are not the market research or the EXPERIMENT. It was done with your clinical excellence, a best practice model inclusive of the literature and a business plan that includes medical primary care providers, medical specialists, urgent care centers, hospital emergency rooms and lawyers.
Right now, you are still at the beginning of this “Wave” [or future trend] and you do not have to change how you treat your patients, how you adjust or whether you believe in subluxation or purely a pain model. All you HAVE to do is work within your lawful scope of practice as set forth by your state and get smarter with a business plan to educate your referral sources, so THEY RUN AFTER YOU. Truthfully, that is the easiest part.