|Dynamic Chiropractic – May 31, 1997, Vol. 15, Issue 12|
By Craig Liebenson, DCThe first wave of managed care has swept through chiropractic practices from Oregon and California to Minnesota and Massachusetts. Cost containment, not quality assurance, has been the diet of the successful managed care organizations (MCOs). By keeping tight reigns on consumers' access and panelists' freedom, costs have indeed come down. Has quality been sacrificed in this pursuit of lowering costs?
Do we know what quality treatments or outcomes are for the conditions we commonly treat? Can we identify those patients who require more intensive or longer duration treatment programs? In fact, there is a wealth of evidence about what treatments are proven to work, what outcomes are sensitive and responsive to the conditions that we treat, and what the risk factors are of a prolonged recovery. In future columns I will describe what we know and show how this can be incorporated into a quality assurance approach to chiropractic practice.
The odds are that MCOs are here to stay. This needn't be a bad thing if we can switch the emphasis from cost containment to quality assurance. In the long term, unless such outcomes as patient satisfaction and pain related impairment or disability are figured into the equation, groups which are buying health care from MCOs will seek it elsewhere.
Chiropractic has an excellent opportunity to assert that it is part of the solution to the cost epidemic of musculoskeletal syndromes. There is a revolution occurring in the management of pain syndromes. The revolution necessitates a new management approach recognizing the following features:
What patients should we be seeking from medical referral? Acute or chronic pain patients without underlying organic pathology can be referred for chiropractic care.
Upcoming columns will address the evidence regarding:
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