Academy of Chiropractic
Quickie Consult 1256
Narratives 99 N
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"Treatment Guidelines are for Suckers"
“You have them just where they want you” Mark Studin 2020
PT Barnum was quoted in the 1850s, saying, “There’s a sucker born every minute.” We have the Mercy Guidelines, the CCGPP Guidelines, the Croft Guidelines, and so many more. These guidelines are well thought out, approved by our national and state organizations, and are published in many authoritative vehicles. They solve on paper, what our profession has been saying for over a century regarding care. Therefore, these guidelines are often quoted by those who follow our leaders' strong advice.
Please note that those who created these guidelines are perhaps, the brightest minds in our industry. These well-respected doctors have created formulas and algorithms to combat the carrier's unfair denials of our claims. In the end, these guidelines did not accomplish what they were intended to do; increase payment and utilization.
The Mercy Guidelines, one of the first chiropractic “guides” for necessary care, was created almost 30 years ago. The questions that beg to be answered are “Are we getting paid more? Are we allowed more treatment? Are we allowed more testing?” Let me answer these questions succinctly, No, No, and No!
Let’s go back to the beginning with both my opening statement and parable in quotes above that. There’s a sucker born every minute, and you have them just where they want you; and that is fighting windmills! We all know how that ended.
Our entire profession has the carriers just where they want you; fighting for fictitious and unreasonable financial outcomes regarding reimbursement. First, the carriers have their guidelines, and should you or any political organization want to challenge them, it is an exercise in futility. Want proof, look at chiropractic reimbursements over the last three decades as a profession.
Even if you win you will almost always lose because at the end of the day, it always comes back to your patient's last re-evaluation. What did you document; Were there persistent positive findings? Has the patient progressed in care? Is the patient actively participating in their recovery?
The only guideline is your last re-evaluation and how thorough it was and how well you documented the findings. Guidelines are based upon population studies, and your evaluation is based upon your patient and not statistics from the 250,000 people’s statistics that were used to come up with an average. Statistics determine averages, and if ½ were far left and the other far-right, where does that leave your patient who typically lies in the middle? The answer; non-reimbursed.
To ensure getting paid, do a thorough re-evaluation every 30 days [mandatory], and do not cut corners in documenting the findings. This is a bullet-proof, legally defensive pathway to payment and avoiding an audit.
NEVER QUOTE GUIDELINES… that is for suckers, who desire not to get paid.