Weathering the unpredictable by recognizing the 3 chiropractic levels of care

COVID showed how DCs need to prepare for the next quarantine or pandemic by recognizing the 3 chiropractic levels of care in your practice

The pandemic caught many practices off-guard and revealed how vulnerable we can all be to the unforeseen. Here are some ideas to help you be better prepared. April 2020 saw 1.4 million health care employees out of work due to the pandemic (Anderson, 2020). COVID shutdowns hurt many sectors, and the chiropractic community was not immune. Practices either had to close and lose patients — sometimes for months — while those that managed to remain open struggled with an extended loss of patients due to quarantines and the difficulties of social distancing in a hands-on profession, underlining the importance of recognizing the three chiropractic levels of care in your practice.

The struggle is ongoing for some. Even now, many functioning clinics are operating at reduced capacity, in part due to staff shortages. Chiropractors are rightfully concerned about how they will cope both professionally and personally if another COVID-level event occurs. Here’s what clinics can do to be in a stronger position for the future.

Create an expansion/contraction levels of care model

The pandemic taught us that shutdowns can be partial, entire, or revoked/reinstated seemingly at whim. This unpredictability catches the public off-balance and significantly alters their care routines, even if chiropractors manage to stay open due to their essential status as care providers.

The key to withstanding such shifts is being able to adjust the level of care provided based on the severity and requirements of the external situation, in tandem with staff levels and patient requirements. A proactive plan of this kind helps prevent clinics from scrambling to create operational models on the fly. A solid plan pillar is clearly defining the three types of chiropractic care you can provide, and then shifting into one of those gears as circumstances require.

For example, be clear on what constitutes conventional, contingency and crisis levels of care in an unpredictable situation:

  • Conventional care will be business as usual.
  • Contingency services will depend largely on being able to follow any guidelines from governing health bodies.
  • Crisis care would occur regardless of external events, providing all urgent treatments and any non-urgent ones which, if delayed, may cause further harm to the patient.

Here’s one constant: Navigating the unpredictable will always require each chiropractor’s best judgement on who should receive which treatments and when. That decision must be made in the context of the national/global event’s severity weighed beside the present needs and potential future state of the patient. An expansion and contraction framework gives practitioners some stable ground by providing options on how they’ll behave even when external events may be unforeseeable.

Consider telemedicine

Pandemics can create a mixture of reluctance and paranoia when it comes to physical contact. People are also simply different. Some are happy to visit a clinic while others would prefer not to. Patients may also have to cancel physical appointments for many reasons.

The good news is that even a hands-on process such as chiropractic can reach out to help patients in other ways during a lockdown or if in-person visits are uncomfortable or impossible. Telemedicine can be a viable alternative to delivering in-person care in instances such as:

  • Patient assessment, recommendations and progress evaluation
  • Stretching techniques
  • Functional medicine
  • Range-of-motion therapy

Telemedicine’s popularity and demand are at all-time highs and are only expected to grow (PR Web, 2021). In fact, clinics that don’t have telemedicine as part of their service could ultimately lose patients and revenue in or out of a crisis situation as the sector grows to be included in the three chiropractic levels of care and worth a potential quarter of a trillion dollars post-COVID (Bestsennyy, Gilbert, Harris, & Rost, 2021).

Telemedicine can be a valuable tool in surviving a rough patch; however, it’s important to deploy this alternative correctly and safely. Be sure you’ve fully weighed the pros and cons and stay aware of the possibility of confidential online meetings being hacked if your clinic is currently utilizing telemedicine or plans to do so (CISA, 2020).

RAY FOXWORTH, DC, FICC, is a certified medical compliance specialist and president of ChiroHealthUSA. He has served as president of the Mississippi Chiropractic Association, is a former staff chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. He can be contacted at


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