The Best of Times, the Worst of Times (Pt. 2)

Part 2 of this series tackles the systemic administrative and financial hardships faced by Doctors of Chiropractic (DCs), suggesting that hostile tactics similar to historical attempts to "contain and eliminate" the profession persist through contemporary business practices. While DCs provide convenient, evidence-based care, intermediary DC networks function to convert this care into a commodity, aiming for the lowest possible cost through utilization controls and suppressed reimbursement. These networks contract DCs individually (via NPI), effectively eliminating the ability to negotiate contract terms and imposing "all or none" bundles. Crucially, fee schedule data required by the 2022 Transparency in Coverage rule show that commercial DC reimbursement is typically well below CMS (Medicare) rates, while other specialties receive 130% or more of those rates. This low, unchanging reimbursement, combined with high patient copays, often leaves patients functionally uninsured, electing to pay cash rather than use their benefits. DCs are further burdened by excessive Prior Authorization (PA) requirements and network profiling based on arbitrary utilization thresholds. Ultimately, the result is that chiropractic care is a profit center for intermediaries who siphon revenue away from the DCs, pushing practices toward the edge of economic viability, causing patients to suffer.