Tuesday, March 1, 2005

Overutilization or Utilization?

by Timothy J. Maggs, DCIssue: March 2005
Chiropractic Products

Are you providing the necessary treatment and recommendations for maximum care

In today’s insurance community, the word “overutilization” is frequently used. Many doctors have learned that overtreating or over-recommending is tantamount to stealing or abuse of the patient, and fear encourages many doctors to recommend less, despite what they believe.

Within many of these doctors lies a frustration that permeates every cell in their bodies. Staying within the guidelines of the insurance industry—using the medical model as the standard of care—will typically lead to limited, or failed, results.

Despite current trends, we know that many Americans suffer from chronic back, neck, hip, and other joint pains that will continue to degenerate at an accelerated basis. The currently accepted model of care in no way provides solutions to these problems. Most low back pains are due to mechanical causes,1 yet we live under a pathology-oriented system that fails to detect or correct musculoskeletal imbalances, weaknesses, or injuries.

More important is the fact that very few physicians are providing the level or quality of care needed to correct the many biomechanical problems that exist today. Most practitioners are drawing a circle around the site of pain, doing localized testing for pathology, and then treating to eliminate any pain that exists. This is what insurance reimburses for, and this is what the public expects. This methodology certainly leads to a more costly and ineffective approach to treating neuromusculoskeletal traumas and degeneration.

Success at the Tour de France

For the past 6 years, Lance Armstrong has competed in the Tour de France. His teams have been cared for by Jeff Spencer, DC. Spencer has worked diligently to keep all of these riders alive, well, and able to participate.

Despite the difficult circumstances and stresses associated with the Tour, Spencer has been able to perform the near impossible: Except for one rider with a broken arm, he has helped every team member become a Tour finisher during the 6 years he has been there. What an incredible accomplishment, especially since only one other team reached that accomplishment this year. The obvious next question: “What did he do to achieve such results?”

Key to Success

Some chiropractors will want to know what chiropractic technique he used, as though that was the difference. Others will assume that all of these riders are professionals and, therefore, were in better shape and should not have had any problems. On the contrary. The demands of this event probably surpass the demands of any other sporting event; 22 days of heavy competition, ranging from 2 to 6 hours a day of competing, not to mention the mental and physical preparation needed on a daily basis. And Spencer helped them stay healthy and competitive, year after year. The simple answer to how he accomplished that feat is the concept of utilization.

Utilization is the art and science of providing the necessary treatment and recommendations, whatever they may be, to attain the goal of finishing the race. Many traditionalists may consider three treatments a day as overutilization, but I would be surprised if anyone associated with the US Postal Team would ever complain about the frequency of treatment that Spencer provided every rider on the team.

Now, let us bring the utilization concept back to our community. Can any of us make the same claim that Spencer can make? Can any of us say that all of our patients have been treated and educated to the level that they are all completing their race, whatever their race is (job, athletic competition, or getting through the day without pain)? Can any of us even begin to make this claim? I don’t think so—not under the current guidelines that exist today.

We must stop using the medical model guidelines when attempting to address biomechanical wellness. We need to begin comparing the needed care for biomechanical wellness to those guidelines in keeping people in shape. It is a conditioning issue—a mobility and flexibility issue. It is not about pathology.

Below is a list of ways that chiropractors and patients alike can begin to redefine the necessary steps in staying healthy and active, even into their later years. It is all about utilization of whatever is needed to get there.
  1. Buy shoes appropriate for your foot type. There are three different foot types (pronator, neutral, and supinator), and there are three different shoe types (motion control, stability, and cushioned). Make sure your patients know what they need.
  2. Get flexible, custom-made orthotics. Full-body biomechanics is the most critical piece of the puzzle for all people who want to stay injury-free. Custom-made orthotic support, combined with chiropractic care, can help restore postural integrity to the entire body. This minor investment will begin the process, and it is painless.
  3. Do not wait until you are broken. We have been programmed to wait until we are sick or injured. Most doctors are unable to do anything for you unless you are sick or injured. But, for better results, you must change that thinking. Structural wellness comes with Structural Management®. Just as you do with your car, your teeth, and your finances, managing your structure will provide a wonderful return on investment.
  4. Do not ask your insurance company for directions. Again, we have all been taught to first ask what our insurance company will cover before we make our health care decisions. Do you think Spencer checked with the health insurance company for the US Postal Team? No, he did not care what they thought. His decisions were based on a goal much higher than the insurance carrier’s guidelines—just as yours and mine should be with our patients. Healthy activity throughout life is the most valuable ability anyone has. Do not lose sight of that.
  5. Manage your muscles better. Listen to them, and aid them in better warm-ups and more complete recoveries. They will either make or break your future, as muscles are a big part of everything we do.
  6. Structural or biomechanical imbalances and distortions are the cause of most injuries. Again, the reason many x-ray reports come back negative from your doctor (“negative,” meaning there is nothing wrong) is because medical x-rays look for pathology or fractures, and in most cases these are not the causes of injuries.
  7. Biomechanics exists above the ankles. Society has come to grips with the fact that podiatrists understand the biomechanics of the feet; however, no one is acknowledging the fact that biomechanics exists throughout the body. If it was acknowledged, then chiropractors would be the “go-to professionals” for everyone, rather than physical therapists (who get referrals from orthopedists who do not know what to do with most injuries).
  8. Standing structural x-rays are mandatory; 75% of the information received when structurally examining someone comes from standing x-rays. They must be taken to rule out pathology, determine biomechanical faults, and teach the patient.
  9. Only a biomechanics doctor can detect biomechanical imbalances and distortions. You cannot go to traditional physicians and hope they will provide biomechanical information. They know nothing about it. They are trained to look for and treat disease, or pathology. In the absence of pathology and symptoms, you would be better off in the hands of an engineer.Only a biomechanics doctor can help correct biomechanical imbalances and distortions. Structural imbalances, fixations, and distortions can improve dramatically, but you must work with someone skilled in locating and correcting them. In many cases, these defects have existed for a long time; so time is needed, just as with most orthodontia work, to make the necessary changes and improve the overall structural balance, joint mobility, and muscle flexibility. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.
1. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Int Med. 2002; 137:586-597.

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