Integrated Chiropractic for CHC Medical Directors

By Michel Tetrault, DC
(Published in March 2003 issue of “Focus” by National Association of Community Health Centers)

Chiropractic is an asset to Community Health Centers (CHCs). The challenge is to help decision makers appreciate the role chiropractic plays as an integrated service in CHCs and to attribute the value it deserves in today’s government funded healthcare safety net systems.

Three key decision makers contribute to the selection of services offered by a CHC: the CEO, the Medical Director and the Board. Issues of available space, funding and other logistical matters fall on the CEO and the Board. This article is intended to assist in developing the Medical Director’s perspective by sharing the experiences of colleagues who currently have Doctors of Chiropractic (DCs) onsite, as well as certain other pertinent facts.

The National Health Services, an FQHC serving the North and Northwest portion of Kern County, California has pioneered the integration of chiropractic since 1992 and generates some 150,000 chiropractic encounters per year in their multiple sites. Dr. Joy Kimpo, a pediatrician, has been serving for years now as its Chief of Staff with a provider team consisting of 10 MDs, 6 mid levels, 10 DDS, 1 mental health provider and 5 DCs.

Inquiring as to the level of success they have experienced with their chiropractic department, Dr. Kimpo explains her philosophy of care: “I believe in giving our patients the best service our team of providers can offer.” Dr. Kimpo proceeds to outline how she has most patients undergo a chiropractic check-up, leaving the decision to the DC in determining if chiropractic care is appropriate to meet the patient’s needs. The Interview goes on:

Q. Dr. Kimpo. Was there a particular case or patient that helped you to better understand the chiropractor’s role; or did this happen gradually over time?
K. “My experience is one of gradual observations that the DCs have in fact been helpful for our patients. When it comes to deciding what’s best for my patients I am confident and completely comfortable now about the role DCs play.”

Q. So, its not just about referring patients who have lower back pain or headaches?
K. “Its part of a new patient’s examination to be seen by the other providers. My goal is to move toward preventive family healthcare and beyond medical triage – into complete integration.”

Q. Can you give an example of how this works?
K. “Take a mother who comes in with lower back pain. She would of course see the chiropractor and her physician would prescribe any medication if requested. The patient would then be instructed to bring in her children for a spinal check-up as well, after which they are directed to the pediatrician to complete their check up.”

Q. How do you manage the perceptions of your own medical providers in regard to chiropractic?
K. “There is a lot of Ego involved here. Lack of familiarity of the scope and benefits of chiropractic services means a lack of trust. Why refer to someone if you know so little about their work? As in my experience, I encourage an environment where information can be shared between providers because the more a physician learns about chiropractic, the easier it becomes to work together. The chiropractors need to make the effort though and discuss cases with the physicians to improve chiropractic understanding.”

Q. What are the top three benefits you can directly attribute to having a chiropractic program onsite at your healthcare centers?
K. “First, it offers access for patients to get chiropractic care within their community center. Second are the benefits of receiving complementary medical services conveniently under the same roof. Third, chiropractic is a good source of revenue for CHCs.”

Q. What would you say about to other CHC Medical Directors about chiropractic?
K. “It is possible to integrate chiropractic, even with limited available space, with innovation and resourcefulness. These barriers will not be very significant compared to the potential of having this revenue generating service.”

In a conversation with Dr. Filomena Trindade, the CHC Medical Director of another small California town named Hollister, the discussion about their new chiropractic program takes a different direction. Due to a positive personal experience with chiropractic, she had been looking forward to adding chiropractic services to their center. The challenge here was to apply Dr. Kimpo’s advice of increasing the degree of information about chiropractic and towards a more “total health” direction. At first, the referrals were strictly for pain management of lower back cases. As the communication increases, the trust does as well and there is the beginning of a greater integration between medicine and chiropractic in this center.

FQHCs, RHCs, and other CHCs are an excellent environment to experience the value of expanding each other’s realm of possibilities in patient care through a comfortable integration model. Of course all of this takes time and some effort on both parts. The outcome is better care for the patients. How bad can that be?

Chiropractic is a covered Medicaid benefit in 35 states and Medicare in all states, but just over a half dozen states have begun to integrate chiropractic in a few CHCs: California, Florida, Illinois, Wisconsin, Pennsylvania, Arkansas and Nebraska. The main reason for the slow expansion of chiropractic services is logistical – basically finding available space. Medical resistance is the second greatest reason for the lack of chiropractic services at FQHCs.

The integration of complimentary care, chiropractic care in particular, into FQHC facilities has been so painstakingly slow that one has to consider if the convicted anti-trust violations of the AMA* continue to have lingering effects within the medical community, in particular in the thoughts and actions of the thousands of Medical Directors of America’s Healthcare Safety Net.

* In 1987, the American Medical Association, along with its co-conspirators: the American College of Radiology and the American College of Surgeons, were found guilty by a federal judge of violating this country’s anti-trust laws for their attempts to “contain and eliminate” the Chiropractic profession. Although these defendants made reversals in their policies, the judge also found evidence that the probability exists that there will be lingering effects of this illegal boycott by members and others exposed to the boycott propaganda that remain uninformed of the outcome of this landmark trial and continue this discrimination.

That may be the official position of the chiropractic leadership but, as a DC providing care within America’s safety net clinics, I would have to agree that, as it has been shared herein regarding Dr. Kimpo’s experiences within a fully functioning chiropractic department, the challenges mostly remain one-to-one between providers; to increase familiarity by cooperation and sharing the care of their patients.

What is needed from the Medical Directors of America’s FQHCs, RHCs and other Community Health Centers is a spirit of “Compassionate Cooperation” instead of a knee-jerk reaction to former models cultivated by covert agendas of organized medicine most practicing physicians abandon with even minor exposure to the true nature of the chiropractic healthcare model. Integrating Chiropractic can be a benefit to your center and is a valuable addition to the Healthcare Safety Net of America.