Many chiropractors treat maintenance patients, but many chiropractors don’t really understand what “maintenance” means.
We can break down patients into three main categories: Active Care Patients, Supportive Care Patients and Maintenance Patients.
An“active care” patient is a patient, new or established, who comes to you with an issue, for which there are no contraindications to chiropractic treatment. For these patients, you have them complete a functional outcome questionnaire for each condition and you formulate a treatment plan with measurable goals for each condition you plan on treating. You track the patient’s measurable progress for each visit and for each condition with regards to the intensity and frequency of each symptom. You begin a thirty-day trial of treatment with a goal of 30% improvement for each metric, but you’ll re-assess at the mid-point of the trial (two weeks or six visits, whichever comes first) with the functional outcome questionnaires. If the functional outcome questionnaires show at least 15% improvement since the previous questionnaires were completed two weeks ago, continue with the same treatment and complete the trial (another two weeks). Rinse and repeat. Active care is typically short-term, but there are certainly exceptions that can take longer.
A“supportive care” patient refers to the patient for whom you’ve done the Active Care regimen with them, but when you do a trial withdrawal of care, they get measurably worse (functional outcome questionnaires). You get them good again, and then do another trial withdrawal of care, but the patient keeps getting worse without getting treatment (as per the worsening metrics of the functional outcome questionnaires). You and the patient determine a frequency of visits that helps reduce the intensity and frequency of exacerbations, but the functional outcome questionnaires don’t change much. There’s no real expectation of achieving functional and measurable improvement with these patients.
A “maintenance care” patient refers to the patients who love to get adjusted on a pretty regular basis but have no symptoms.
Most new patients fall into the“active care” category. Patients are willing to pay out of pocket for this typically short-term care. Medicare and all insurers are happy to pay for treatment of patients in this category.
For the supportive and maintenance care patients, most insurance doesn’t pay for this anymore, so the patient would have to pay out-of-pocket for their care.
So, when starting with a new patient, it’s best to determine which category suits them best.