Prepared by John J. Collins, DC

Important background information for medical providers:
In Oregon (just like all 50 states) chiropractors are legally classified as "Primary-contact" health care providers. There is NO legal requirement for medical referral. Chiropractors are legally responsible and liable for:
1- Establishing a 'diagnosis' and plan for any 'condition/s' they intend to treat.
2- Managing the patient's case appropriately as per the state CHIROPRACTIC (not medical!) laws and statutes.
3- Referring the patient to other health care providers when necessary (i.e. where there is reason to believe that lack of appropriate medical evaluation and/or care will result in significant and/or lasting detrimental health effects). All chiropractors are sufficiently-educated and prepared to reasonably identify patients with conditions that are outside of the chiropractor's scope of practice.

MDs/DOs/NPs/PAs should be aware that not all chiropractors are the same in their philosophy and/or clinical approach! Like many medical physicians, most chiropractors (including me) are resisting the commoditization, standardization, corporatization, centralization, and dehumanization of health care! Many of us are justifiably pessimistic regarding 'evidence-based medicine' as we believe it marginalizes some of the most valuable and cost-effective areas of health care. Chiropractors will likely continue to defend their right to practice clinically-diverse, conservative, patient-centered care. MDs and DOs should remain open to working with any and all types of chiropractors, as these relationships will ultimately result in improved health outcomes for your patient.

More background: As you may know, lots of people visit chiropractors! Perhaps 15-18% of the population attends a chiropractor each year and approximately 50% of the population have seen a chiropractor at some time. Over a 7 year period from 2000-2006 I myself rendered care to over 1200 different patients...this is approximately 4% of the Greater Newberg area! And, there are 9 -10 other chiropractors in the area, so perhaps 30-40% of the people in the Greater Newberg area have visited a chiropractor during those years!

Let's Collaborate!

Insurance Coverage/ Payment Issues/ How To Refer

Statistically, a growing number of people are obtaining "chiropractic benefits". However, much of it is unreasonable/irrational managed care coverage. I only participate in a very limited number of PPOs (2 exactly). I have found that participation in MCOs have resulted in lower quality of care and I prefer to work directly with a cash-paying patient. Most patients at my office do not have so-called chiropractic "coverage"! As a result, our fees are very reasonable and fully disclosed before care commences (ie. initial exam:$100, x-rays(if needed):$50-100, typical treatment $45-85. My staff will either already know or be able to quickly determine precisely what coverage (if any) is available. Leave it to us!

How To Refer The Patient:

(First, there is a difference between a 'referral' and 'prescription'! I am no longer honoring "prescriptions") [i.e. please treat 3 times for SI dysfunction etc.] I have grown to believe that MDs/DOs have no more business "prescribing" chiropractic care than they do "prescribing" dental care! However, given that the scope of MDs and chiros overlap, it is appropriate for an MD to request that a chiro limit their care to a particular issue/problem/symptom. I will usually gladly comply with your request.

Typical referral requests might be worded as follows:
1) Scenario #1: (full referral for chiropractic management) example--- "Dr. Collins, please evaluate and treat patient for her chronic headaches/backaches/injuries etc., send initial and progress reports."
2)Scenario #2 (co-management, MD is primary) example--- "Dr. Collins, please evaluate and treat patient limit eval and treatment to xyz symptoms/condition. Send initial and progress report." (If I disagree with your rationale for requesting a limited scope, I will make my opinion known to you without usurping your clinical authority, but you need to be able to defend your clinical reasoning.)
3) Scenario #3 ("prescription" for chiropractic care): example---"Dr. Collins, please treat patient with spinal manipulation for S.I. dysfunction with 3 treatments." Now, imagine referring your patient to a dentist and advising the dentist which teeth needed to be filled and which ones needed crowns etc???
Please do not send me a patient with a "prescription", I will NOT honor it, thanks. Remember, I humbly and gratefully accept your thoughtful referrals, and will do my absolute best with each and every patient.

Sincerely,

John J. Collins, DC
Newberg, OR