Wal-Mart: Killing a Forehead Fly with a Hatchet
(Editor's note: The following two letters were written in response to the article "Largest Private U.S. Employer Axes Chiropractic" regarding Wal-Mart's decision to stop covering chiropractic services. The first is a copy of a letter sent to Wal-Mart chairman Rob Walton from the Kansas Chiropractic Association; the second includes a letter to H. Lee Scott, Wal-Mart's CEO. For a related story, see www.chiroweb.com/archives/20/25/20.html.)
Dear Mr. Walton,
I am writing to you on behalf of the Kansas Chiropractic Association regarding a recent letter sent to chiropractors across our state. The letter stated that you were forced to make some tough choices and that you will no longer cover claims for chiropractic services. Without our expression of concern, we are afraid that many will be denied necessary and cost-effective services for
spinal-related problems. Additionally, we feel that your rush to action has chosen a path that is counterproductive, more costly and discriminatory.
Without question, Wal-Mart is the most successful corporation in modern times. In a company that advocates equality and the American spirit, your choice is a major deviation of the standards of care. You have rejected not a service, but a profession that is more cost-effective and effective in the treatment of spinal problems.
The main reason patients go to the chiropractor is because they have pain. To eliminate access to chiropractors you have not eliminated the need of these patients to have their pain treated. They will simply be forced into other portals of care, and those portals are more costly. If you had eliminated the use of traction, diathermy, manipulation, or any other service, but did it across the board to all provider groups, perhaps it would have been more acceptable. However, your new policy allows the patient to continue receiving spinal manipulation and physical therapy services from MDs, DOs, and PTs, and you have only eliminated chiropractic services.
Obviously, there must some impetus or reason for such a drastic action. Without a doubt, you will create considerable angst with your employees, who will be forced to pay out-of-pocket, or go to another provider against their choice. However, we would encourage you to reconsider your decision and not "throw out the baby with the bath water." Perhaps you have encountered a bad experience with a chiropractor that moved you to make this decision. However, it is wrong to make such an obtuse change against a profession that is a very cost-effective, natural choice for many of your employees. It is also possible that you have been given bad information or advice on the true cost of chiropractic services.
We would like for you to take a few minutes and review the "Lumbago Treatment" by BCBS of Kansas that compares provider groups to the cost incurred in treatment of an episode that is grouped according to diagnosis. The average number of physical therapy units by a chiropractor is 2.65 per visit, compared to 8.85 by a physical therapist. More importantly is the global cost of an episode. Patients cannot be seen by a physical therapist unless a medical doctor refers them. Therefore, you must add the cost of the MD, the PT, medications, hospitalization and all other associated charges. Patients who visit the chiropractor are never referred to the physical therapist, never hospitalized, are not prescribed medications, and avoid MRIs and many of the expensive diagnostics of the hospital setting. It is very important that the global cost is considered.
What is so paradoxical about your decision is that it not only will offend millions of Americans; it will also increase the health cost to your plan. You would not want to "kill a fly on your forehead with a hatchet," but that is exactly what you are doing with the decision to eliminate chiropractic services. If there are problems that have been identified with one or a group of chiropractors, it would be a much better solution to deal directly with those providers than restrict access to the entire profession. The more access you allow your insured to visit good chiropractors, and the more you restrict access to their medical doctors, the greater the savings to your plan will become.
It is our sincere hope that you will reverse your decision to discriminate, and allow your patients to access conservative, cost-effective chiropractic care of their choice. We feel that this will save money for your plan and provide safer alternatives for the treatment of back disorders.
Please feel free to contact us at any time to discuss any other possible resolution that might not be as harsh or carry as many encumbrances.
Brad Dopps,DC
Secretary, KCA Insurance Relations Committee
Topeka, Kansas
Listen to Reason Dear Editor,
The ACA is taking a somewhat confrontational approach to Wal-Mart's decision to eliminate chiropractic benefits. In addition to that approach, it might be beneficial to challenge Wal-Mart to put chiropractic to the test.
Wal-Mart, or any other company, does not care if we are hurt by its eliminating an employee benefit. It does care about its own "bottom line" and employee morale.
Following is a letter I sent to Mr. Scott, the CEO of Wal-Mart. It has little chance of being graced by Mr. Scott's eyes. However, if his office were to receive 2,000 or more similar letters, it might possibly draw some attention.
If Wal-Mart took us up on such a test, and if we could deliver the goods in the marketplace, such an event could have an astounding impact on our profession.
Let me urge the readers to join me in this effort.
November 4, 2002
H. Lee Scott
President, CEO
Wal-Mart Stores, Incorporated
702 SW Eighth Street
Bentonville, Arkansas 72716
Dear Mr. Scott:
It is puzzling to me as to why a cost-saving benefit such as chiropractic would be eliminated from your employee health benefits.
There are so many studies demonstrating the health and cost-effectiveness of chiropractic care that such a decision is hard to understand. The claims for chiropractic care, industry-wide, are less than one percent of the total claims. In accounting, a CPA would say that such a figure does not even meet the test of materiality in fiscal terms.
The phenomenal success of Wal-Mart testifies to the fact that there is an extremely competent and intelligent management team in your company.
Since chiropractic is in a position to save Wal-Mart millions of dollars annually, why not perform a test? Solicit 500 volunteers from among your employees to receive care for a limited period of time. (I have some suggestions regarding treatment protocol.) Then, compare those 500 employees to 500 others who received no chiropractic care. Compare the lost days of work, general health status, and overall health care expenditures.
If chiropractic delivers concrete benefits, you will then be in a position to extrapolate them on a company-wide basis. The potential savings are in the millions.
David L. Williamson,PhD,(abd),DC
Durham, North Carolina
Keep "Looking" Dear Editor,
Dr. Jonathon Sevy's article "Look Again" is one of the best and most provocative discourses on the subject of chiropractic and the VSC I have read in quite some time. He asks some penetrating questions regarding our principles and practice. In my 40th year of practice, I, too have asked the same questions.
All during my time at Palmer, I was interested in the psychological/emotional side of the health triad. Nip Quigley knew that there was a definite psychological component of the adjustment from his experience as director for the Clearview Sanitarium. Aside from the adjustment, the only "treatments" for the psychological/emotional side of the triad were signs and cards with the words "Keep Smiling!" - a positive outlook, but more than what is needed.
There have been a number of individuals who have "looked again." John Diamond, MD, a psychiatrist from Australia working with applied kinesiology, made great advancements in his practice using the meridian system and manual muscle testing. Roger Callahan, PhD, a clinical psychologist, after attending a 100-hour course on applied kinesiology, "looked again" and developed the techniques now called "thought field therapy," using the beginning and end points of the acupuncture meridians that produce a rapid way of curing phobias.
In 1981 Callahan presented a paper, "The Five-Minute Phobia Cure," to the International College of Applied Kinesiology, which brought back my interest to "look again." After numerous personal communications with him I incorporated his methods in my practice, and my patients got better results.
Scott Walker, DC, developed the Neuro-Emotional Technique (NET) independently, after wondering why the subluxation continued to come back, adjustment after adjustment. His initial technique featured sequential adjustments of the spine, while the patient thought of the emotional component. He has gone on to develop an extensive foray of additional ways to treat and correct physical and emotional problems and has founded a nonprofit research organization dedicated to exploring the psychological/emotional side of the triad and chiropractic.
In 1991, finding that Callahan's work at that time was somewhat limited, I began writing a book that went much farther. It was completed in 1994. Unbeknownst to me, the book was being used extensively in the new area of energy psychology. The Association for Comprehensive Energy Psychology, whose membership consists primarily of psychologists, psychiatrists and mental health counselors, gives immense credit to the chiropractic profession, and particularly Dr. George Goodheart, the discoverer of applied kinesiology, for the discovery of manual muscle testing as it relates to physiology and psychology.
Goodheart discovered that if a person is congruent with a thought or statement, a previously strong muscle would remain strong. If the person made a statement or had a thought in which he or she were not congruent, the previous muscle would weaken to manual muscle testing. This has been researched and found to be reproducible by Dan Monte, MD, et al., in a paper published in 1999 in a refereed journal.
In the Association for Comprehensive Energy Psychology we have a great number of friends we have previously not known about who are doing research on this subject.
William Tiller, PhD, is one of the world's leading scientists on the structure of matter and was a Stanford professor for over 30 years. In his book, Science and Human Transformation, he talks about chiropractic and specifically applied kinesiology as a practical and accurate way to discover what is happening in the psychological and emotional realm. He points out that there are subtle energies that have been measured that influence the physical and emotional aspect of humans. His most significant discovery, in my opinion, was that the intention of the healer has much to do with the outcome of the treatment!
I emphatically agree with Dr. Sevy in his statement, "If a subtle energy component is predominant in our results, shall we embrace it, research it, and master it to more directly correct the cause of all disease?"
James V. Durlacher,BA,DC,DIBAK
Mesa, Arizona
