Dear Editor:
Thank you for your understanding the human side of fighting the Federal Trade Commission (FTC) battle.
How can I be repaid for time I missed playing with my son and daughter? Some ages are so priceless, and we can never get them back. Kids can feel the stress their parents are carrying in ways we adults may never understand. And how can my wife be repaid for the stress she had to endure, or for watching me struggle?
Dealing with federal attacks is different. The lowliest mugger can face his accuser in court, but I cannot. Those nameless, faceless individuals who attacked me and the profession through a federal agency don't have the courage to stand up and face me, my family or the chiropractic profession.
In contrast, the response from the profession has been overwhelming and wonderful. I think people are slowly beginning to understand how much danger we were in, and how close we came to being gagged and muzzled for our professional lives. Imagine not being permitted to give a lay lecture or to speak to patients about chiropractic care for children or vaccinations. This is what those at the FTC wanted, but we stopped them.
Let us learn from this. I hope the next time a DC is attacked (and there will be a next time), we will be better prepared.
Tedd Koren,DC
Gwynedd Valley, Pennsylvania
No Regrets on Changing to a Cash Practice
Dear Editor:
After reading a recent letter regarding negative experiences with ASHP, I thought your readers would like to hear from someone who has succeeded in regaining my freedom to practice.
In 1988 I discovered that after four years in practice, I was losing control of my life and my practice to increasingly dictatorial insurance companies. At that time, I made the decision to change to a cash practice and have never looked back or regretted that decision. I must emphasize that when I converted to cash, I did not lose my entire practice or go broke. In fact, I only lost one patient, and my practice has continued to steadily increase since that time. My treatment decisions are made solely between myself and my patients; I have the freedom to come home after work and be completely off work (no reports or paperwork left over at the end of the day), and I can look myself in the mirror each morning with pride.
Since many doctors and students requested information about how I converted my practice, my wife and I wrote a short book detailing our procedures. One of the most prevalent issues raised by "insurance" doctors is that they are disturbed by having to fabricate diagnoses and causative factors to get paid by managed care. They feel they are being forced to compromise integrity for their survival, and would rather be in another profession than submit themselves to potential fraud charges. How many good chiropractors are we going to lose because of their moral consciences?
Another concern of insurance DCs was that by following the HMO guidelines for numbers of treatments allowed per diagnosis, the doctors were setting standards of treatment the insurance companies could later use to deny treatment. In other words, if six office visits are allowed for a certain diagnosis, the doctor only treats and bills for six, then "creates" a new injury or condition just be able to continue treating the patient until they achieve results. This sets the standard that the specific diagnosis can indeed be "cured" in only six office visits. They are also reluctant to use "vertebral subluxation complex" as a diagnosis, for fear of complete denial of treatment. Therefore, the vertebral subluxation complex will cease to exist as a chiropractic condition and be replaced by "sprain/strain" or some other innocuous diagnosis.
An epigram from the walls of Palmer College reads: "Following the paths of least resistance is what makes rivers and men crooked." It takes courage, integrity and commitment to return to your roots as a subluxation-correcting chiropractor rather than an "insurance provider."
Having a cash practice does have its obligations, however. It forces me to discuss chiropractic philosophy at every opportunity, and to achieve results from my technique in order to justify the cost of my treatment.
There is extreme accountability for my actions when I am asking people to pay for those actions out of their own pocket. There is also extreme satisfaction in seeing those people's trust in me rewarded by their recovery and subsequent referrals of friends and family. The true value of my treatment is established by the full amount the patient pays, not by the few dollars of co-payment required by their insurance.
Having a cash practice also has tremendous rewards. My patients have freely chosen to come to me; they have not come because I was on some list provided by the HMO. They receive genuine attention and treatment from me.
My attention is not distracted by thinking up diagnoses or objective findings to support my insurance claim. I have the freedom to treat even the most severe cases without having the patient wrenched away from me because the insurance company did not think it was a chiropractic case. Note: Some of you may have read my article in JMPT (Feb. 1997): "Management of a Patient with a Lamina Fracture of the Sixth Cervical Vertebra and Concomitant Subluxation." Do you think I would have been allowed the freedom to treat that case were I a member of an HMO?
The time has come to return to our roots of patient influenced, subluxation-oriented, fee-for-services practices. The chiropractic profession can only benefit by the expansions of cash practices and the increase of direct accountability to the people we swore an oath to serve.
David Abblett,DC
Concord, California
BCBS's BS?
Dear Editor:
I would like to start by saying that I regularly enjoy Dynamic Chiropractic, and generally find materials in it that help keep me aware of political and group issues that affect our profession.
My concern and reason for this letter revolves around a column in the August 13, 2001 issue titled "Report of My Findings." The subject matter was rather positive and originated from a statement made from Dr. Allen Korn, chief officer of the national Blue Cross/Blue Shield Association (BCBS). The statement read that BCBS believed that chiropractic shouldn't be part of CAM, because we were too "mainstream" to be considered "alternative." The editorial went on to say how exciting it was to be called mainstream and not alternative. This is where I had to stop and think carefully about what hadn't been mentioned, or apparently thought of, in that editorial.
First of all, why do you think BCBS would want to go out of its way to take a stand and persuade anyone involved with CAM that the chiropractic profession needed not be considered alternative? After all, CAM would be a way to get federal money for research that our group is always under attack for not having enough of! By pushing us out of that circle, we lose potential ground financially for our research to show how and why we should be a primary choice for most maladies - before drugs and/or surgery.
BCBS isn't ever going to do us any favors. Look at how many of your pages are covered with updates on current lawsuits against it from chiropractic groups. Do you think it would polarize any statement about chiropractic that would help improve the public's perceived efficacy and thereby possibly increase demand for third-party reimbursement?
Any statement such as this should be scrutinized and carefully considered as only a move to undermine our progress as a group.
Don't get me wrong: I don't think that every association is out to get us. I'm not paranoid, but I'm also not na¥ve or gullible.
Many doctors (DC) are apathetic when it comes to propagation of our profession, to the point of no interest of issues that do or will directly have an effect on them. Your publication is one of the most widely read for our group that I can think of, and as such, has a responsibility to help us all consider political ramifications of statements like those made by Dr. Korn.
Mathew Kays,DC
Loveland,Ohio
The NCAA and Chiropractic
Dear Editor:
I appreciate your article regarding Dr. Michael Petty at the recent NCAA Outdoor Track & Field Championship (see "Chiropractic at the NCAA Track and Field Championships," DC, August 13, 2001 or http://www.chiroweb.com/archives/19/17/10.html).
I am the team chiro for the Arkansas Razorbacks, and was on hand to see them awarded the title we have won over 37 times. I have known Mike Petty since meeting him at midfield before the Arkansas-Tennessee game four years ago. He and I are the only official and traveling chiros in the Southeastern Conference. We are trying hard to get the attention of other teams to help our profession.
Dr. Sid Williams has helped by publishing articles about us in his college's magazine, even though we are not Life graduates. We could use your help as well. NCAA Track and Field has been very supportive of chiropractic, and the larger-scale sports are now realizing what we have to offer. If there is any way that you could help our cause by publishing this, please do.
Thanks for your support.
Steven Whitelaw,DC,CCSP
Fayetteville, Arkansas
"...will we continue to steal from others whenever we please?"
Dear Editor:
If it weren't for the fact that people listen to him and that he is serious, Dr. Winterstein's article, "Broad Scope and Proud of It" (DC, August 13, 2001 or http://www.chiroweb.com/archives/19/17/21.html) would be laughable. It does not matter what Dr. Howard thought or said. He does not define chiropractic any more than I do, or any of us, for that matter. Chiropractic already has a definition. It is "...a philosophy, science and art of things natural. A system of adjusting the articulations of the spinal column by hand only for the correction of the cause of dis-ease." (Stephenson's Chiropractic Textbook, 1927.)
Similarly, all those other things that Dr. Winterstein is so proud of doing all have definitions, too. In fact, they all have entire professions and schools dedicated to performing those same services. If he were speaking truthfully, Dr. Winterstein would have said he is multidisciplinary and proud of it.
To be multidisciplinary, one has to be properly trained in all the multiple disciplines. I still have not received a satisfactory answer as to why some of our profession feel that a weekend course or a 300-hour course qualifies us to duplicate the services of someone that spent four years in school, just as we did. Our licenses may legally allow it, but ethically and morally - it is wrong.
Since Dr. Winterstein brought up the issue of ethics, I believe he should answer the question: What is ethical about stealing? Why do we feel that we have the right to steal from other professions? We cry "foul" when medicine bullies chiropractic or when anyone else tries to manipulate (the term used most often by MDs, PTs and most national grads) the spine, but then we turn right around and do the same thing. Is it any wonder that the physical therapists want to duplicate our services? Chiropractors have been stealing from the physical therapy profession for years. This "new" movement by the physical therapists is merely the natural progression of something that chiropractors started years ago with the ideas set forth by John Fitz Alan Howard.
One of the epigrams found in James Allen's As a Man Thinketh reads: "When man breaks man's laws, we lock him in a cell and point the finger of scorn at him. When man breaks nature's laws, we take him to the hospital and bring him flowers." What happens when we break ethical and moral laws? One thing that I guarantee will happen is that those responsible for the backlash will do everything except take responsibility for their actions.
Dr. Winterstein's attempt to "piggyback" on contemporary science by calling himself and those like him "quantum physicians" is shameful. If anything, the field of quantum physics is turning our founding fathers' philosophical writings into fact. Many of the ideas being developed by quantum physicists today are almost verbatim from Stephenson's 1927 text!
Subluxation theory is far from anti-allopathic rhetoric. In fact, it has nothing to do with anti-allopathic rhetoric. The rhetoric may come from the presenter but it is not in the principle or the theory. Ideas like the "safety-pin-cycle" were developed to provide an intellectually tangible concept to represent the subluxation theory. Saying that subluxation theory is anti-allopathic rhetoric is just another dirty trick that Dr. Winterstein uses to make himself appear more believable.
As for the lack of evidence supporting subluxation theory, that depends on what you will accept as proof. For some, seeing their patients achieve and maintain a higher state of function, performance and achievement after correction of their subluxations is more than enough. For others such as Dr. Winterstein, only a double-blind RCT will suffice. Ultimately, when it comes to proof, we have to think of the bumblebee. Mathematically it should not be able to fly. Physicists say it should not be able to fly, yet it does. So, which is wrong - our eyes or our science?
Now is the time for our profession to make a decision. Are we going to conduct ourselves in an ethical and moral fashion, or will we continue to steal from others whenever we please? This is the real battle that we face. I understand Dr. Winterstein's position on wanting to do whatever he can to help a 'sufferer.' I choose to do something far greater for humanity than most people could dream, and I do something that no other profession does: I introduce a force to a spine. That force is then adapted by the body to unlock the potential that is within all of us, but dormant in so many. I correct vertebral subluxations so that an individual's light may burn brighter and light the way for humanity.
Chiropractic is chiropractic. Dr. Winterstein is multidisciplinary. And I am Dan Lyons, chiropractor
Dan Lyons,DC
Oregon, Wisconsin
"...fires can start with a single match."
Dear Editor:
I have watched with interest the case against ASHP in California. Earlier this year, upon the urging of some patients who wanted me accepted on their plan, I applied to ASHN (another American Health Specialty entity) for certification in order to participate in Cigna. After filling out numerous forms and having my office evaluated on-site (all of which wasted a great deal of time), I was denied acceptance, because I use muscle testing over reflex points. There was no scientific evidence that this practice has validity.
Isn't it interesting that the lack of scientific validity was for many years one of the main arguments against chiropractic? And even while chiropractors were being called unscientific (or worse names), thousands of people received benefit from chiropractic methods.
Actually, I was relieved at receiving a denial because I did not wish to work even harder at documentation for less reimbursement. I have begun to encourage patients and insurance representatives at the electric company, and anyone else who will listen, to register complaints against those insurers who use ASHN as their credentialing agency. I know that I am just one person, but fires can start with a single match.
In Arizona, it is being reported that another insurer is now offering more benefits in alternative care. Through them, patients can purchase nutritional supplements and other health-care-related items. Isn't it interesting that insurance plans will not cover these items dispensed from our offices, but will sell the items to the patients? Validity and effectiveness only seem to be in question when the "wrong" people are being paid!
I encourage others in the profession to move toward the type of plan studied in Illinois, where the chiropractor is the primary care provider.
Linda Judd,DC
Benson, Arizona
An All-Too-Common Tale
Dear Editor:
He enters through the big double column doors and pulls open the large brass antique doorknobs. He has an old 1940s doctor bag and a portable table. He walks quietly up to the front desk and asks the receptionist what room number his client is in. She directs him to the first room on the left. He continues down the hall toward the first room on the left and passes a couple of senior citizens wheeling slowly along in their chairs. He says emphatically, "Good Morning." The woman slowly looks up and smiles, her motion hindered by years of marriage to "uncle Arthur," better known as arthritis.
The man continues to the first room on the left and sees another resident, but it is not his client. On the other side of a white curtain, dividing the room in half, the young man can hear the "Price is Right" blaring from a midsize TV. The older gentleman looks up sternly from his television set and says, "I thought they were gonna: send someone qualified." The younger man laughs and replies that the older man sure hasn't changed any - still ornery as ever. At that moment, the orderly walks in the room and asks what the younger man is going to do today, to which he replies, "Oh, just a little massage and some stretching." The orderly leaves with a puzzled look.
That "young man," in case you haven't guessed, is me.
A treatment is given consisting of working on the acupressure points for Parkinson's, stretching the hamstrings, knees, low back and upper extremities, followed by passive mobilization with minimal audible release.
I walk to the elderly man's miniature refrigerator and retrieve a miniature can of Seven-Up, drinking from it as the man and I talk about exercises for strengthening his legs. And again, the orderly returns. He asks the older gentleman if he feels like new, and the older man replies that he does feel better.
The orderly then turns to me and asks if I am a chiropractor, and I put up my fingers in a cross formation, much the same way you would fend off a vampire in a horror movie. "Don't say that evil word," I reply. "Yes, I am a chiropractor. I have been this gentleman's chiropractor for quite some time." I proceed to fold up my table and bid my patient farewell. I almost make it to the big double doors with the antique brass doorknobs, before the orderly asks me to step into the administrator's office. I feel like I am back in high school, being sent to the principal's office.
The administrator wants to know if I have doctors' orders to treat the gentleman, and I tell her I have been his doctor for some time. She insists that we needed doctors' orders for him to be treated. I tell her I'm not a real doctor, and that I merely play one on TV; she is not amused. So now, I have to ask permission to treat my patient.
My query is this: If I had walked in, wearing my clinic jacket and name tag and tie, instead of a T-shirt and a pair of sweats, would I have made it past the double doors? If I wouldn't have told the orderly that in fact, I was a chiropractor, would I still have had to go to the "principal's" office? I guess the older gentleman's fate lies in whether or not this medical doctor is open-minded enough to think that what we do might just actually work! For the sake of my patient - I sure as hell hope so!
James Womelduff IV,DC
Peculiar, Missouri