CONA President's
Message
EVER FELT SUCKER PUNCHED? --Believe it or not, with the recent passage of the health care reform bill we were born to survive. Every year there seems to be some new challenge our profession is exposed to and we seem to face it head on. So who knows how we'll be included in the next 90- days, and in the months and years to come. One thing for certain, the language of the bill doesn't look too promising if taken literally, and can be interpreted in any number of scenarios depending upon the wind direction, coastal water temperature, or the barometric pressure on a day to day basis. Such uncertainty reminds me of the ending of the quintessential Clint Eastwood movie that ends with a three-way duel in the cemetery.... Eastwood says to the man unharmed, "In this world there are two kinds of people, those with loaded guns, and those who dig." I just hope we're the one's who know the location of the treasure in the grave marked "unknown," and uncover the 8- bags of gold. With hailing the victory of non-discrimination we'll need to accept the changes just like the movie’s title, The Good, the Bad and the Ugly.
Reading between the lines, I'll admit the startling trend of institutionalized care becomes more of a reality today than ever before. What customarily was an office based profession for most all health care providers 35- years ago including DO's, MD's, DPM's, OD's and DC's alike, it’s rapidly becoming large scale multi-disciplinary consortiums, and the administrative controls associated with them. Many chiropractors want equal recognition, non-discrimination, and reimbursement parity yet without the risk, obligation, or responsibility —along with the freedom to "opt-out" of the health care system completely if they so choose all while enjoying the benefits that other health care professions have. To do so or expect it to be true is the equivalent of blaming health care reform for the wetness of water. It's silly, naïve, and patently dishonest to expect both.
The upside is that we fill a need not offered by other disciplines... that's because we create, collect and preserve health every time we touch someone. The only thing is, other health disciplines just don't get it yet. Some will, some won't, so what… but others will sooner than later.
Consider this. When it comes to economics and the health care dollars to be spent, someone outside of health care e.g. the team lead by the Secretary of Health and Human Services is going to decide what constitutes essential medical services. What sort of criteria do you suppose will be used to determine the value and importance of acute, prophylactic or preventative chiropractic services over the need for crisis care, chronic conditions or catastrophic illness caused by an individual's lifestyle choices?
Notwithstanding others who offer a variation of our art and science in the form of wellness care, or manual orthopedic therapy in one form or another, the growing popularity of what we do should not be ignored —because believe it or not, others covet it because of the low risk, low investment, and relative ease of delivery to compared to other disciplines. You'd probably agree there's little outside competition for your dental health except between the legions of dentists competing for your business. The same holds true for your vision health and optical needs except between various franchise models and competing optometrists. Yet unlike any other profession, we share our unique value and utility with many others, and this creates unusual competition shared by licensed and unlicensed persons alike.
Consider this, Acupuncture, Athletic Trainers, Naturopathy, Osteopaths, Neurologists, Orthopedists, Physiatrists, Physical Therapists, and Occupational Therapists, already have mobilization/manipulation in their scope of practice, while the growing numbers of unlicensed massage therapists, and natural health practitioners are encroaching also. Taking various kinds of myofascial release courses encourages their boldness, or other techniques we use such as IASTM along side DPT’s and DC’s. This confuses even the most well informed patient, and those people who are accustomed to seeing a chiropractic doctor regularly. This confusion should sound an alarm, and may very well be the reason that chiropractic is sometimes valued by our patients more by our individual affability, and availability when it comes to a person’s access to us, and can out weigh our skill, competence, confidence, experience, and clinical training as we perceive ourselves —especially when it comes to satisfaction in our work and the benchmark of a successful prosperous practice. To confuse the reasons why people choose us and why we think we’re successful is like trying to compare oranges to MP3’s.
Convincing the policy makers in the next 2-3 years could be more difficult than convincing the other 85% of the population that we ARE an essential medical service they should demand, and have unfettered access to. When it comes to value and perception though, it seems to be the same old story from our very inception, and the acceptance we enjoy today is the same fraction of the population as before… and those are the people who get it.
Okay, so we are an essential medical service, everyone should know that by now... After all, it's the 21st Century... Yet by what standards will we be held to that assures what we do is provided as efficiently as possible and without any duplication by others? The choir is singing and the words must be just as clear for the policy makers as it is for those who choose to practice chiropractic because there's no margin for error these days, and our clinical skills must be exceptional and without rival otherwise our chiropractic patients may choose to go elsewhere for a knock-off version that's subsidized with some form of 3rd party or other government program offering something similar. It all depends upon what the future holds for all licensed healthcare providers being replaced by less expensive individuals... Heck, I read a surgical report last week involving a multilevel cervical fusion with hardware; the “assistant surgeon” was a PA. Believe me, we're not alone in this, and we need a smooth finish to a rough day at work.
Our cohesiveness is critical for the upcoming consolidation, and the changes that lay in wait ahead. There's no better time than now to be proactive, and by joining CONA, you can learn the skills necessary in order to choose between our eventual integration into the ranks of primary care if you so desire... or decide to embrace the day-to-day solitude practicing alone in your office. For the time being it’s still a matter of choice. Regardless, from here on out you will be measured three ways, first if people like you, second if you’re accessible, and third, if you're lucky enough, by the value you offer the patients who choose you, with the evidence you back it up with. Believe me when I say, you’re only as good as your patient’s last visit.
Tools are good if you know how to use them —luckier yet if you can use them more than one way. Ever used a crescent wrench as a hammer, or a screwdriver as a chisel? CONA is a tool, and offers the leadership and the direction needed to navigate the newly created mine filed of healthcare reform. Our membership has decades of combined real world experience as a resource you can rely on; many considered experts in their own right. More than being a source of creative problem solving, CONA is a venerable group of individuals who realize there is safety in numbers. This by the way reminds me of a book in my library, "Bread for the Wilderness, and Wine for the Journey" by John Killinger. A guide of sorts for someone who feels lost even though the countryside seems familiar. Let CONA help you help yourself with the health care changes confronting us ahead.
Sincerely,
Lewis N. Meltz
