William E. Morgan, D.C.

The biggest barrier to chiropractic integration into mainstream healthcare is not found in the attitude of the chiropractic and medical providers as much as it is a financial barrier. It does not matter how well chiropractic is received, if it is a financial burden to the treatment center. If third party reimbursement organizations continue to discriminate against chiropractic multi-disciplinary clinics may not be able to afford to have chiropractors.

What financial barriers hamper chiropractic integration into hospitals and specialty clinics? A partial list would include: the restrictions of private chiropractic managed care organizations, Medicare limitations, workers compensation limitations [in states like California ], and anemic Medicaid reimbursement. Aside from inadequate third-party payment, the higher overhead associated with multidisciplinary clinics and hospitals also can reduce the profitability of having chiropractors present. In a hospital the cumulative cost of maintaining accreditation standards, 24-hour staffing, and expensive salaries and equipment elevates the cost for all services in a hospital. For medical specialties this expense is offset by an increased reimbursement for hospital-based services. For the most part healthcare coverage will not increase chiropractic payment for hospital-based services.

I often receive inquiries from chiropractors asking how to get hospital privileges. However in my opinion they are asking the wrong question; getting credentialed by a hospital is extremely easy, developing a profitable hospital-chiropractic model is difficult. If you develop a profitable model for the hospital, the hospital will make sure that you are credentialed.

Potential solutions

Affiliate with a Doctors' Hospital.

A Doctors' Hospital is owned and operated by doctors for a profit. These hospitals have the opportunity to negotiate and contract directly with local employers and insurance companies. One of the downsides for joining a doctors' hospital is the mercenary reputation that they have with insurance companies. In fact, doctors who have a business interest in any hospital may be accused of "cherry picking." Cherry picking is when doctors send their patients with good paying insurance to their hospital and those with poor insurance or no insurance to other hospitals.

Promote patient-directed care.

The emergence of Health Savings Accounts (HSA) has the potential to being a tremendous boon for chiropractic in and out of integrated settings.

This program essentially is an insurance policy with a high deductible, but the deductible is funded tax-free in an interest bearing savings account. The money in the HSA can be used by the patient for health care without having to get approval from an insurance company or managed care organization. This results in empowering the patients to choose their own care and to shop for affordable care. There is much more that could be said about HSAs*.

Add to the overall appeal of the clinic or hospital.

From a patient's point of view would you rather go to surgical center for your back care or to a multi-disciplinary spine center replete with chiropractors, physical therapists, and other conservative non-invasive specialties? Simply by adding to breadth of treatment options, a chiropractor can make a pain clinic or spine center more popular with patients and more profitable.

Various Government programs fund chiropractic integration.

The VA, DOD, rural health programs, community health center programs all have models for profitable chiropractic integration, albeit on a limited scale.

Finally, the best solution would be to gain the cultural clout to move past the current chiropractic reimbursement model and to be treated on par with other health care professionals. This will only come about through corporate efforts in promoting cultural authority, perceived worth, high quality research, ethical conduct, and fair governance.

* For more information about Health Savings Accounts consider these sites: