Dear Editor:
I read with great interest the interview with Gerald Weis, DC on managed care (see "Silver Lining to the Managed Care Cloud" in the January 26, 1998 issue).
I have met thousands of chiropractors and have not yet met one who runs a managed care practice that I would suggest anyone model. Perhaps Dr. Weis and I define practice success differently. Here is mine: a balanced life; serving people not paper; high volume; high referrals from thrilled patients who are expanding chiropractic; exceptional service; high profit; low stress; low overhead; low hours; fun in practice; security; and principled practice without compromise.
The only people I hear who have anything good to say about managed care are those DCs who are lining their own pockets with silver by reviewing/cutting off care, or those who have some direct financial interest in a managed organization.
We don't need to make a meal out of the crumbs that fall off the medical plate. Forget the bits of silver: get out from under the mangled care cloud and develop a cash practice. Go for the gold. You and your patients deserve the best.
Robert D Martines, DC
Campbell, California
Tel: (408) 378-1881
Fax: (408) 378-6020
Say Goodbye to the Gravy Train
Dear Editor:
Kudos to Dr. Weis for providing a concise yet clear picture of managed care in the '90s. I practice in a market with over 90% of the insured population enrolled in one of five HMOs. As a profession, we have to realize that we must understand and adapt to the managed care model if we are going to effectively operate within it. As Dr. Weis so aptly stated, the "gravy train" of indemnity insurance is long gone.
The chiropractic paradigm of maintenance/wellness care does not fit into the symptom-based/medically necessary/chiropractor-as-specialist model of managed care. If symptom-based care makes your skin crawl, then stay away from managed care and go to a cash practice. But please stop thinking you can change the current paradigm of managed care into what you want it to be.
John M. Ventura, DC, DABCO
Rochester, New York
Tel: (716) 227-7720
Fax: (716) 227-7858
Vent5-aol.com
A New Slogan?
Dear Editor:
I just received the latest issue (Feb. 23, 1998) of Dynamic Chiropractic. The first line that drew my attention was the slogan at the top of the front page, "The Touch is Mightier than the Drug."
I really like that. It is emotionally and spiritually a very strong message. It is the truth. Thanks for the good job.
Andy Nayak, DC
Marietta, Georgia
It's a Wonderful Profession
Dear Editor:
Regarding your January editorial, "It's a Wonderful Profession" (see the January 23, 1998 issue), I want to say a special thank you to you, even if I'm late. I had put it aside to let you know about it. I apologize for not letting you know more often how much we appreciate all the work that you do.
Keep going. We always look forward to reading you.
Aylmer Baker, DC
Sainte Foy, Quebec, Canada
Manipulating the Data?
Dear Editor:
The story on "Chiropractic Use Going Up" (see the Feb. 23, 1998 issue) was interesting and encouraging. But the author(s) were a bit careless in interpreting some statistics from the Landmark survey. On page 38, it states that "if you take that figure into account (i.e. 73%) and divide it into the 42% of the population who say they have sought alternative care, that would mean that 31% of all adult Americans -- just over 61 million in all -- have visited a chiropractor at least once in the last twelve months."
This is illogical and poorly expressed. They could be accused of adjusting or manipulating the survey data. Taken literally, it is simply contrary to fact. What the author meant to say is that if we multiply the 73% "who would most likely use" chiropractic sometime with the 42% of the population who are actually users of alternative care, there is a potential for chiropractic use to reach the thus-derived 31%.
Good luck, and I trust the profession does all it can to get closer to that potential.
Pran Manga, PhD
University of Ottawa
Ottawa, Ontario, Canada
Manga-admin.uottawa.ca
Rational, Ethical Providers or Philosophical Zealots?
Dear Editor:
The article by Dr. Freeman in the March 9, 1998 issue had the potential to help practicing chiropractors better understand medicolegal definitions and advance our profession. Unfortunately, it was nothing more than another chiropractor attempting to find a way to continue to bill third-party payors.
The brief definition he used for maximum medical improvement is a selective part of a broader definition that was proposed by Sportelli, Foreman and Stahl in their text, Medicolegal Issues for Chiropractic. The part he fails to mention is the section that states, " ... when there is no further potential for additional healing and the patient's subjective values have been established on an upper and lower level scale." This means you have provided a focused, unbiased treatment plan for the patient's condition as it relates to the one traumatic event (motor vehicle collision injury or work injury) and the patient reports the same upper and lower pain values and functional scores across a two- to four-week period. The next step is to have the patient settle their third party claim, and if they elect to continue with care, it would be at their own expense.
You see, life is a continuous cycle of cumulative trauma. We have physical stress; financial stress; personal stress; and the natural process of gravitational stress that occurs with aging. These automobile and work traumas are one more trauma onto a body system that works on fatigue mechanisms. The ability of a physician to be fair to the patient and the third party payor is a difficult process. It is clear, though, that ongoing care follows the old saying, "More of the same gets you more of the same." These injuries are worse than some people think and better than others think.
The medicolegal community is full of hidden agendas that are mainly motivated by either money or psychological distress. As a profession in this evolving information age, we will be identified as either a good alternative for treating traumatic injuries or a bad alternative. Meta-analysis studies will follow patients into their geriatric years and document the natural progression of these injuries and the efficiency and effectiveness of each treatment modality. We can either move forward into this scientific information age as rational ethical providers of health care or philosophical zealots that speak philosophy and think money. The difference is transparent to all outsiders.
Albert Einstein said, "Insanity is doing the same thing over and over again, expecting a different outcome." What is going to be the difference between your last visit and the next, if it is not substantially contributing to close the case or refer out?
Scott Rosenquist, DC
Colorado Springs, Colorado
An Open Letter to Kiki Herfert
(Editor's note: the following letter was sent in regards to the February 23 article, "My Insurance Girl Quit -- Now What?".)
Dear Ms. Herfert:
Perhaps your insurance child (girl or boy) would still be with your office had they been respected as adults, or at least addressed as adults. A girl is a female child, just as a boy is a male child. Unless you employ child labor, I really bet your insurance staff member is an adult woman, maybe with children of her own.
One of the many reasons I chose to become a chiropractor, instead of a medicator/surgeon after working as an RN, was the allopathic system's deep disrespect for (and sexist, misogynistic attitude toward) woman patients or coworkers. I can still recall one of their "scientific" sexist descriptions of diagnosing a cholecystectomy. Their cute little demeaning phrase was called "the three F's": female, fat and forty.
The chiropractic profession is of course far ahead of allopathy. Let us not continue their use of old, sexist, unprofessional terms to describe woman coworkers. For those who think "girls" is complimentary, try calling a male adjustor an insurance boy.
I hope you can understand this. This may seem trivial, but our cultural terminology says a lot. When the legal drug pushers call us "quacks", it's not because we look or walk like ducks. It's used to attempt to take away our power. My intention is to promote more appropriate communication for all of us. I also correct my patients, associates, and vendors or suppliers if they call my staff members children. They usually understand and thank me for increasing their awareness.
Susan Zimmer, RN, BS, DC
Marshall, Virginia
"Very Impressed" with DC's Website
Dear Editor:
I read again about your website in the most recent issue of Dymanic Chiropractic, and I am very impressed now that I have seen it for myself. The links section alone makes this site worth visiting over and over again.
There are givers and takers in all areas of life. You, like your father ahead of you, are a real giver. Thank you, and carry on.
Richard M. Burger, DC, CCSP, DIBAK
San Diego, California
joyof10-cts.com
(Editor's note: Dynamic Chiropractic can be accessed online at http://www.chiroweb.com/dynamic.)