While the majority of musculoskeletal cases respond quickly and favorably to conservative care, some conditions are less cooperative. When a patient is not meeting outcome goals, evidence-based chiropractors must be willing to abandon their familiar recipe, and “do something different.” In a value-based healthcare model, there’s a vast difference between merely treating someone vs. delivering best practices. The essential step for improving clinical outcomes is to provide the most effective care for every patient on every visit—including those cases that challenge us.
ACA’s Choosing Wisely recommendations are consistent with X-ray guidance in today’s classroom and trusted texts.
In the past year, many chiropractors have discussed indications for radiographic examination with renewed interest. In particular, they have questioned the X-ray recommendations of the Choosing Wisely initiative, a project of the American Board of Internal Medicine that seeks to promote more effective use of healthcare resources. The recommendations are hardly revolutionary, and well in line with current radiology education. In my own final radiology classes, professors emphasized that what we learned was only the foundation of what we would need in practice, and a mere fraction of what our peers would learn should they choose to become chiropractic radiologists. The recommendations in Choosing Wisely are shorthand for what we already know.
It has been just over a year since many in the chiropractic profession first learned that the American Chiropractic Association (ACA) joined more than 80 medical specialty society partners to participate in an initiative that is sponsored by the American Board of Internal Medicine Foundation. This initiative’s mission is to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” It is called the Choosing Wisely campaign1 and it has generated more spirited discussion among doctors of chiropractic than I can recall since release of the Mercy Conference Proceedings in 1993.
It's been 30 years since ACA senior scientific advisor Christine Goertz, DC, graduated from Northwestern Health Sciences University. As she prepared to give the commencement address to the NWHSU class of 2018 this spring, Dr. Goertz couldn't recall the words of wisdom from her own commencement day...but, looking back, she knew exactly what she wished someone would have advised her as she embarked on her career in chiropractic. Read her Top 10 list of recommendations for this year's new graduates.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) officially ushered in the value-based model of reimbursement, beginning a change to the payment landscape of American health care. But what does this mean to providers? What does it mean overall for you as a chiropractic physician? First of all, we shouldn’t be afraid of the deck being “reshuffled.” Anytime there is a change in a system – especially a system that has delayed or avoided change – it becomes ripe for an innovative, landmark transformation.
Long before many of us can remember, there were only two people sitting in the chiropractic treatment room – the patient and the doctor. Gradually, the state licensing boards starting showing up. They were joined by the insurance industry. Then health policy makers like Medicare and Medicaid. Followed by more members of the insurance industry. Then scientists made an appearance, talking about evidence-based clinical practice. Now this already very crowded room may become even more crowded if we open the door to the ever-loudly-knocking performance measurers. We have had time to get at least somewhat used to the state and national boards, insurers, policy makers and even the scientists, to some extent. But what is performance measurement and how might it be beneficial to the practice of chiropractic?