A graduate of Palmer Chiropractic College in 1996, Dr. Craig Hennequant has been spending much of the past four years working with chiropractors nationwide to help them become more evidence-based and improve their documentation and care management. In his interview with The American Chiropractor (TAC), Dr. Hennequant describes his findings and the future of chiropractic.
TAC: Tell us something about yourself.
Hennequant: Well, I think I should start by sharing with you what my mother told me when I graduated from Palmer in October of 1996. She said, “Son, always remember, people don’t care how much you know until they know how much you care”. Giving my best every day, helping individuals that were on their last hope and making lasting impressions on people’s lives is a rewarding job that comes with great responsibility. In the last five years, I’ve broadened my objectives from not only helping individuals in my practice, but also helping the profession…because I care. I care what happens to our patients, to our doctors and to the profession.
For the past five years, I have been consulting nationwide with chiropractors, medical doctors, insurance adjustors and attorneys. In the late ’90’s and early 2000’s, the company I represented focused primarily on billing and coding; but, in the last three to four years, I’ve done more and more research in documentation, objectification, the Health Care Financing Administration (HCFA) and the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, to help chiropractors get more evidence-based, while improving their documentation and care management.
Most recently, I’ve been traveling as a consultant, representing Myo-logic and Spinal Logic Diagnostics. I am most fortunate to spend quality time teaching and learning from the top people in our profession on a regular basis.
TAC: There has been a lot of recent concern about the changes in California’s reimbursement and workers compensation laws. Can you share with us what is happening?
Hennequant: Not too long ago, a senate bill (SB 899) passed that will change the way doctors in California handle workers compensation patients. Specifically, it limited the amount of visits a patient can have with chiropractors and it changed the way the doctors need to examine and objectify the patients’ injuries.
TAC: What has caused this?
Hennequant: Looking at the past, we can evaluate a couple of different causes of this. One, the former guidelines didn’t allow for proper checks and balances within the system—which didn’t hold the practitioner accountable for their services. This led to cases in the 20, 30 and 40,000 dollar ranges for chiropractic care. Now, I’m not going to say whether this was over or under utilization; but I will say that, the majority of time, there was no evidence or objectivity to support such a high level and term of chiropractic care.
TAC: Do you see what is happening in California as a trend?
Hennequant: It has already begun to change things. Many states have, by now, capped care or have fee schedules in place and others have changes in the works. I am hearing more and more stories everyday, consulting with doctors across the US, about how their laws are changing for the worse. Chiropractors are facing a different reality today than 5, 10 or, especially, 15 years ago. Many DC’s are considering going to cash practices or moving to different states; but I don’t think that is the answer.
We are faced with these changes and problems, primarily, due to our not documenting properly or doing nothing more than orthopedic testing or, at most, taking plain film X-rays.
What is taught in chiropractic school hasn’t changed much in the past 15 to 20 years or longer, with regard to our exam process; but things are evolving dramatically around us. We are taught orthopedic exams, which are positive about 1% of the time, and are considered subjective in nature. Too many chiropractors are not equipped with the knowledge to properly u assess a patient’s injury and or illness according to the latest research, guidelines and standards.
TAC: What can chiropractors do to make a difference?
Hennequant: We need to have better documentation that is evidence-based, not subjective based. It is necessary to have orthopedic examination be first, but objective documentation needs to follow, to support our working diagnosis and have more defined care management. We also have to be more educated in the latest accepted guidelines, research and standards that are widely accepted across the disciplines.
The importance of using proper objectification and care management is paramount; this will prove that chiropractic works, to those beyond our patients and ourselves. This is the only way that we will change the views of the politicians, attorneys, insurance companies and the masses that have the most influence on our future as a profession. We need to show them through an “objective (I understand) system, rather than a subjective (belief) system,” (the latter of which has not been working since the early 1900’s, hence the problems we are now facing).
We also need to make this a habit. In his book, The 7 Habits of Highly Effective People, Dr. Stephen Covey defines a habit as the overlap of knowledge, skill and desire. It is evident that we are usually lacking one of the three. Some lack the knowledge, some the skill, while some lack the desire. Each doctor needs to evaluate which of the three he or she is lacking and improve each until it becomes habitual.
It is also imperative for chiropractors to get more involved with their local, state and international chiropractic associations. I can’t say enough about what our top organizations are doing. When you join and support an association, you’re supporting the “life” of chiropractic. When you pay those dues, you are making an investment in chiropractic that goes toward helping fund research, pay our lobbyists and keep our profession alive.
TAC: What are the accepted guidelines that our readers should be aware of?
Hennequant: HCFA, Croft’s Guidelines, and the AMA’s Guidelines to the Evaluation of Permanent Impairment, 5th Edition, (specifically Chapters 1, 2, 15, 16, 17 and 18) are the most widely accepted standards that we need to understand. They put us on the same playing field as any other practitioner, no matter the profession.
You have two choices, you can crack open the CPT Guidelines and AMA Guidelines and get studying, or you can attend a seminar which will bring you up to speed. Either way, ignorance is not an excuse any longer. Whether you adopt an understanding or not, you will be affected by this trend if you’re not affected already. Changing to a cash practice or moving to a different state is only avoiding the issue and not helping the profession. We need to get more educated and objectify as doctors. We get paid to think and do paperwork, not to see patients. That part is rewarding enough. It’s OK to be paid for our services, help people, and have a successful practice at the same time.
TAC: What are some final words of advice?
Hennequant: We have a responsibility, to ourselves, our patients and the profession, to be evidence-based in our practices. No matter what technique you employ or how you define “subluxation”, you need to objectify properly and be evidence-based according to the accepted guidelines. The more chiropractors providing that type of care, the fewer problems we will face in the future, and the more accepted chiropractic will become.
I challenge each and every chiropractor to address his/her weak area(s), whether it’s knowledge, skill, desire or a combination of the three. If it’s knowledge, get to a seminar or open a book or two. I feel it is absolutely necessary for doctors, at least 3-4 times per year, to get out of the office and go to a seminar. Usually, it’s not the skill a chiropractor lacks; we get plenty of practice. It is usually knowledge and/or desire that hinder most doctors that I consult. Practice, at times, can become monotonous or confusing; and a lack of desire can stem from frustration and a lack of knowing what to do. Either way, getting out of the office and being recharged with new information, re-kindling that desire to be a chiropractor, and meeting new people who share the same interest is very therapeutic.
Use evidence-based objectification in your office, like that which is available through companies such as those featured in this magazine. Many of these systems use all of the above mentioned accepted guidelines, put it all together for you and even write your reports.
Renew your belief in what you do, educate yourself in the latest objectification standards, and prove that chiropractic works and is the leading health care choice in the world.