No longer in the background

Chiropractic medicine folding more seamlessly into comprehensive patient care

Story by MaryBeth Matzek

When Dr. Kent Belville began his career as a chiropractor 20 years ago, most patients came to him on their own accord and most paid out-of-pocket for their treatments. Today, it’s not unusual for a neurologist or a family medicine physician to refer patients to Belville. And insurance companies pick up the tab – just as if the patient was visiting their family medical doctor.

“The barriers between medical doctors and chiropractors are breaking down,” said Belville, who operates Belville Fletcher Chiropractic in Oshkosh and Berlin. “Referrals from a medical doctor were unheard of 20 years ago.”

The reason for the change? An aging population that is more interested in natural remedies and a decision by the State of Wisconsin in the 1990s that required insurance companies to provide equal coverage to chiropractors and medical doctors.

“That really opened the door for many people and gave them more choice,” said Ron Leonard, executive director of the Madison-based Wisconsin Chiropractic Association.

And patients are taking advantage of it.

A survey conducted by the Wisconsin Chiropractic Association and St. Norbert College found that 51 percent of Wisconsin adult residents have seen a chiropractor in the past five years.

“That clearly shows people are interested in receiving care in a more natural way,” Leonard said.

Why the growth in chiropractic?
Chiropractors diagnose and treat patients whose health problems are associated with the body’s muscular, nervous and skeletal systems, especially the spine. Chiropractors earn a bachelor’s degree before attending a four-year program at an accredited chiropractic college.

They must also be licensed by the state.

The industry has definitely grown as people become more sedentary. In 1990, there were 700 chiropractors in Wisconsin. Today, that number is 1,800, Leonard said.

The Bureau of Labor Statistics predicts the number of chiropractors in the United States will grow faster than the average job growth over the next five to seven years as the demand for more natural approaches to health care continues to grow.

“There has definitely been a growth in back problems and government studies have consistently shown that chiropractors provide the best treatment for lower back pain,” Leonard said.

Belville says back problems bring in 75 to 80 percent of his patients. Other common problems involve the neck area and headaches.

Belville works closely with patients’ primary care providers or other specialists to make sure they are informed of his diagnosis and treatment plan.

“It’s a very collaborative relationship. We want to work together on what’s best for patients,” he said.

When a patient comes in with a problem, Belville often does an adjustment – a hands-on manipulation of the area causing the trouble – and provides them with some exercises to help keep the problem from coming back. If a problem persists, physical therapy may be prescribed.

Dr. Douglas Hendricks, a physical medicine and rehabilitation physician with the NeuroSpine Center of Wisconsin in Grand Chute, said working with chiropractors is integral to the work he and the other NeuroSpine physicians perform on a daily basis.

“We address many of the same patient problems and diagnoses but in different ways. Because of this, we are able to complement each other quite well to essentially team up together to give our patients the best of both worlds and hopefully the best possible outcome,” Hendricks said. “I refer many patients to chiropractors when I believe he or she would benefit from the treatments provided by the chiropractor including, but not limited to, hands on work, manipulations and modalities.”

Like Belville, Hendricks says the relationship between medical doctors and chiropractors has improved dramatically in the past 10 years. By recognizing what each side brings to the table, patients benefit from this collaborative environment, he adds.

“It is refreshing to be able to work in this sort of environment, especially when I think back to the old school-type of relationship, which was clearly inferior to the way things are now,” Hendricks said.

Insuring chiropractic care costs
Dr. Kevin Pursel, director of chiropractic services for Arise Health Plan, has been a chiropractor for 15 years and while he has heard stories about poor relationships between medical doctors and chiropractors, he has never experienced that himself.

“The best approach tends to be collaborative treatment,” Pursel said. “It’s an integrated approach involving surgeons, physical medicine physicians and chiropractors.”

The relationship between chiropractors and medical doctors also has benefited from a recognition that chiropractors are sometimes the best resource for patients. A study released recently in the Annals of Internal Medicine indicated spinal manipulation – which is done primarily by chiropractors – is the best method of treating lower back pain.

“If a health care system or insurance provider is following best practices – which means providing the best care for their patients – they have to support chiropractic care since it has clearly been shown to be the best choice for some kinds of problems,” said Pursel, who indicated Arise Health Plan is one of several Wisconsin-based health care insurance plans which has agreements in place with dozens of chiropractors in northeast and central Wisconsin, designating them as providers for the network.

Some healthcare systems have recognized the value of having chiropractors and medical doctors working closely together. Aurora Health Care, for example, has chiropractors in some of its clinics working side-by-side with medical doctors. That arrangement, however, has not been implemented yet in any of Aurora’s clinics in Fond du Lac or Winnebago counties.

As for the insurance companies, Belville said patients don’t question whether or not their chiropractic care is covered.

“They know they will have to pay a co-pay or a percentage, just as if they were seeing their family doctor,” he said. “My concern is for those without insurance who are staying away because they worry about costs. Those people aren’t getting the care they need.”

Pursel said Arise realizes the easier it is for chiropractors to refer to a medical physician and vise versa, the happier patients are about their care.

“Chiropractors are concerned there may be pre-service requirements, but since we’re an HMO, we treat chiropractors the same way other primary care physicians are treated,” he said.

While insurance companies are now paying chiropractic patients’ bills at the same level as bills attributed to medical doctors, Leonard still has concerns the insurance industry isn’t doing enough. For example, Leonard said many patients have high co-pays that may keep them out of the doctor’s office.

“The high co-pays some patients have keep them out of the office for minor issues, but those small issues may develop into major – and more costly – health concerns,” he said “Chiropractors and medical doctors are all concerned about access and all the other issues that all health care providers face.”

MaryBeth Matzek is a freelance writer based in Appleton.