Addressing the State of the Profession

Editor's note: The following is an excerpt from a speech given to the Federation of Chiropractic Licensing Boards on May 5, shortly before the 2004 NBCE-FCLB annual meeting. It has been edited for continuity.

This past year, in addition to presenting to numerous state boards, I had the opportunity to visit and speak at more than a dozen chiropractic colleges, including delivering the commencement address at my alma mater, NYCC. In visiting our colleges, I was impressed by the diversity, as well as the tremendous vitality present on our campuses - and in our classrooms.

I would like to share a quote with you. This quote appeared in the Millbank Quarterly of the Medical College of Wisconsin, volume 81, number 1, 2003, page 127, in a report by Richard A. Cooper and Heather J. McKee, titled "Chiropractic in the United States: Trends and Issues."

I quote: "In previous decades, chiropractors did not want their profession to be considered as a form of medical practice. Even now, many see themselves as practitioners as a distinct art. Having crossed the chasm into the reimbursed world of health care, they must now prove their quality, effectiveness and value. The profession is buttressed by satisfied patients and sympathetic politicians, and by the general longing for someone who will listen and be supportive. But as our aging nation struggles to define the health care system that it can afford, it is uncertain whether this will be enough."

As a management consultant, I function in that real world that exists after a doctor of chiropractic graduates from college, and before he or she appears before your board for the correction of some unfortunate misdeed. Having spent 45 weekends last year on the road addressing chiropractic audiences across the country, I would like to share with you my report of findings.

The practicing chiropractor, from new graduate to pre-retiree, is ill-equipped to meet the challenge described in the Cooper and McKee report. If you would allow me, I would like to share with you my opinion on what must be done if, as a profession, we shall rise to meet the opportunity the authors present to us.

1. Chiropractors must learn to master the art of documentation, so that they can effectively communicate the value of their work to interested third parties.
2. Chiropractors must practice with a standard of care that is based upon empirical evidence. This means that they must learn to objectively document the functional improvements that their care has upon the ability of their patients to carry out their activities of daily life, and how these outcomes impact the quality of these lives.
3. Chiropractors must take their heads out of the sand and realize that in order to participate in the mainstream of health care reimbursement, they must become compliant with the standards of ICD-9 CM and CPT coding, as outlined in the Office of the Inspector General's Compliance Guidance to Small Physician Practices. This includes, at a minimum, not upcoding or downcoding; properly linking diagnostic descriptors; appropriately applying coding modifiers; and using only those codes that specifically describe the service or procedure they perform.
4. Finally, chiropractors must learn that it is only by combining our philanthropic efforts that we can reach a level of financial commitment, as a profession, that can impact the legislative process that truly controls the purse strings of chiropractic reimbursement and recognition.