On the other hand, today's consumer wants to make informed choices and decisions about their care. Plus, the internet is revolutionizing health information by satisfying patient’s increasing demand for information, empowerment, and convenience.

“Now is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill

Every 8 seconds a baby boomer turns 50. The loss of flexibility and the inability to move freely means baby boomers will become less active, and have to stop doing what they enjoy. However, I believe many boomers will not want to stop "doing" as they age, and will do everything possible to maintain an active lifestyle. The demand for services and products that can keep ageing bodies moving will soar.

This bodes well for chiropractors with biomechanical practices providing the services people want, such as, massage, yoga and other posture exercise, as well as LifeHabit advice. Those practices successfully integrating managed care with personal pay will prosper most of all. The Chiropractic Opportunity is in creating a practice where patients choose RehabCare and WellnessCare, even after their HMO/PPO has paid for the doctor to successfully treat the patient in AcuteCare.

The Phases of Care

A Patient Choice practice initially evaluates and appropriately treats an AcuteCare patient for a short term of care. The goal in AcuteCare is to get the person out of pain (or significantly reduce the pain) and back to more normal activities of daily living. Patients are asked to sign an Informed Consent form, and are advised that they will be re-evaluated at the end of the initial trial of care. The concepts of AcuteCare, RehabCare and WellnessCare are introduced. Insurance reimbursement is explained as covering AcuteCare. Additionally, the patient is assured that they will be advised when insurance limitations mean they are financially responsible for continued RehabCare or WellnessCare.

The insurance company is billed and all patient co-pays are made at the time of visits. Keeping patients current with co-pays is easy with a front desk sign stating "To maintain our fees, we charge a $20.00 billing fee for co-payments not made at the time of the visit".* View/Download Sign During the two to four weeks of AcuteCare, the patient is taught basic self-care for their problem and basic posture stretches.

After the AcuteCare trial, the patient fills out a self-assessment questionnaire and is evaluated.

• If the patient is unchanged, they are referred as appropriate.

• If a patient is improving but still symptomatic, care may be continued under AcuteCare for another short term, as appropriate.

• If the patient is asymptomatic, they are given the option of being dismissed from care, or continuing care in RehabCare (or WellnessCare, if appropriate). The patient's financial responsibility for RehabCare, progressive posture exercises, massage, or other treatments is clearly explained. If the patient chooses to discontinue care, they are advised to call if/when their symptoms return for AcuteCare under their insurance. A Consent for Continued Treatment or Dismissal form is given to the patient to sign.

Many patients will opt only for AcuteCare and then decide to be dismissed. All are more likely to refer to the practice where they were not pressured, but allowed to choose the care they felt was right for them. Many will successfully manage slight pain recurrences with the self-care and basic posture stretches they were taught. However, if the patient’s symptoms return, they will return to the physician who treated them with respect and attempted to intelligently educate them on how to care for their problem. And since biomechanically based back problems tend to recur if there is no change in behavior, when the next AcuteCare episode occurs, patients are much more likely to consider the benefits of keeping their body moving, feeling, and being well with RehabCare and WellnessCare.

Steven P. Weiniger, DC / Founder, BodyZone.com

This is one of a series of articles on integrating Managed Care, insurance, and personal pay in a practice treating patients for AcuteCare, RehabCare and WellnessCare. If you agree with the Patient Choice philosophy of care, and believe this is the intelligent path for our profession, I’d like to hear from you-- Email me at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it .