The article begins with descriptions of two cases, both alleging chiropractic overutilization. The first is of a masonry worker in his early 30s who was treated by a DC for over a year. At the onset of the injury, he had initially been approved by his employers and insurance company to go to the emergency room. The treating physicians there "determined that the injury was minor and would treat itself with time and that he could return to work." The employee disagreed and went to a chiropractor. The insurance company questioned the DC's diagnosis and refused compensate for a year's worth of chiropractic treatment. The insurance company finally settled for about 50 percent of the charges and an agreement to further treatment by a chiropractor of the carrier's choice.
The second case involves a 70-year-old woman who fell at her office. After using different methods of therapy to no avail, she was sent to a DC who treated her for about two years. The author comments that the chiropractic treatment had "little effect" and that the insurance carrier had no indication of how long the treatment would go on. The carrier, who is now contesting the claim within the state, spent $3,400 on this treatment and another $700 getting second opinions.
After dutifully reporting these two case histories, the author informs readers that according to the National Council on Compensation Insurance, chiropractic care accounts for only six percent of $1.25 billion spent annually on Florida's workers' compensation medical costs. So why all the fuss? Because chiropractic is gaining what the article calls "a bigger slice of the workers' comp. pie." And even though the author admits "...it's hard to build a case against chiropractic as the nub of what's wrong with workers' comp.," there is this blanket indictment of chiropractic:
"Yet, critics of chiropractors are flush with examples of abuse -- not only of workers milking the system but also of chiropractors aiding and abetting workers by extending treatment unnecessarily and saying patients are more injured than they really are. The chiropractic industry has also become linked to the money-grubbing side of contingency-fee lawyers, creating for each other a steady flowing pipeline of patients and legal fees. What's more, the chiropractic profession is becoming increasingly marketing oriented, teaching its members to push cradle-to-grave care and offering what seems to be more seminars on patient retention techniques. And to make sure that none of this comes undone, chiropractors have built up one of the most effective lobbying organizations in Tallahassee."
On the subjects of chiropractic overutilization, the author interviewed people who use the chiropractic profession as a scapegoat for Florida's rising workers' compensation costs. Hence, the following quotes:
- Ken Hacker, a spokesperson for the American Insurance Association says in the article, "Sometimes I think of workers' comp. as the chiropractic full-employment act."
- Mary Ann Stiles, a lobbyist for Associated Industries of Florida and a member of a panel that sets fee schedules for workers' compensation is quoted, "I don't see why chiropractic should be considered basic health care providers when they overtreat and overcharge. They have abused their right to be in the system."
- W.D. Jacobs, senior vice president and corporate counsel for Sarasota-based FEISCO (the largest workers' compensation insurer in Florida) says, "Chiropractors have chosen to find a marketplace for their services that is intimately involved in litigation."
In addition, the article conveniently quotes members of the profession chastising other chiropractors for ripping off the system. The author presents this quote from Dr. Sid Williams, president of Life College:
"'Some members of the chiropractic profession have been engaging in what amounts to 'crime and wicked conduct' in their practices by jumping on the bandwagon of getting all they can from the insurance industry while the 'getting' is good. They have been playing a numbers game of getting as many patients visits and as many dollars per visit by whatever means they [and often their practice management consultants] can devise ... This has led to a truly embarrassing and sordid situation for chiropractic.'"
It is up to the chiropractic profession as a whole to prove articles such as this one wrong. Insurance companies are directing more of their attention towards investigating what chiropractors do, and this is a chance to stress the absolute necessity and effectiveness of chiropractic treatment. Chiropractors can turn this situation into a plus by emphasizing studies affirming chiropractic like the RAND study, the Meade et al. study in the British Medical Journal, and the Cherkin low back pain study. The majority of DCs, who practice ethically and professionally, will set an example eclipsing the one this article presents. Instead of backing away from this spotlight, DCs should take advantage of the opportunity to shine.
Barbara Migliaccio
Second Assistant Editor