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Dynamic Chiropractic – December 1, 2013, Vol. 31, Issue 23

Advancing the Primary Spine Practitioner

By John Ventura, DC, DABCO

A large New York Blue Cross / Blue Shield plan hosted the formal inaugural training program for primary spine practitioners (PSP) on Sept. 28-29, 2013. Ninety-five health care providers participated in the program, which included DCs (70 percent of attendees), as well as DPTs (20 percent), PTs (8 percent) and MDs (2 percent). The program was taught by Donald R. Murphy, DC.

An understanding of the role of the primary spine practitioner is best understood from the following:

"This individual, the primary spine practitioner (PSP), is provided specific training, tools and support to augment existing attributes regardless of the provider's specific discipline. The PSP role allows for the existing professional workforce to be re-purposed and fill the need for first contact, best evidence, low cost management of all spine related disorders regardless of severity."1

Spine-related disorders are among the most debilitating and costliest health conditions our society faces. Over the past three decades, we have witnessed exponential growth of costs related to spine disorders, with current estimates approaching $90 billion a year. These direct costs of diagnosing and managing spine disorders include a 400 percent increase in opiate use, 200 percent increase in spine fusion surgery and 600 percent increase in use of epidural steroid injections. We have seen the indirect costs, those evidenced by disability / impairment / lost productivity, as also rising at an exponential rate, and currently may be 1-5 times as high as the direct costs.2-5

To solve this problem, a patient-centered, evidence-influenced model of care was developed that includes the PSP as the "quarterback" of spine care. Murphy, et al., have written about the specific skill set of the PSP.6 Fortunately for our profession, DCs require the least amount of additional training to meet these requirements compared to other professions involved in spine care.

The training program is unique and unprecedented in that it is currently being done through a large BC/BS insurance plan and implemented as a BC/BS community initiative to help reduce variation in spine care, reduce waste and increase the value of care delivered, where value is defined as quality outcomes / cost. The effort is to train the PSP to effectively and efficiently evaluate and manage the vast majority of spine-related disorders. Additionally, the PSP reaches out to all key stakeholders to bring them into the continuum-of-care pathway. The end result is a high-performance network of providers.

So, what is the significance of this event and program for the chiropractic profession?

  • Expanding our role
  • Bridge-building
  • Career opportunities

If we consider that two of the chiropractic profession's greatest difficulties are a lack of trust by the public (three national surveys show DCs score the lowest on scale of public trust for all health professions) and a limited percent of the population utilizing DC services (consistently about 8 percent over the past 50 years), we can see how the DC functioning as a PSP helps to solve both problems. DCs functioning in the PSP role serve to enhance our cultural authority (perceived legitimacy and competency), and as the PSP helps to decrease the variation and costs associated with spine care, our value to employers, insurers, and all of society rises exponentially.

Increased trust will increase the percentage of the population that seeks our services. And once the public trusts the provider, the services they seek from this provider will expand.

The PSP role also serves to build bridges with the public, employer groups and other professions, in much the same way it serves to expand the chiropractic profession – we gain cultural authority and in so doing, gain trust; therefore, more people utilize our services.

Additionally, helping to solve the dilemma and cost of spine care ensures our participation in any future health system. The PSP meets the Center for Medicare and Medicaid Services (CMS) tri-mandate for better care, better outcomes and lower costs, as well as CMS requests to "repurpose" the existing workforce.

Whatever direction health care reform takes, we (DCs) want to be included. Helping health care to solve the spine dilemma increases the likelihood of our inclusion. This BC/BS program is a big step in ensuring chiropractic participation. (Becker's Spine Review, a widely read online magazine for those working in the field of spine care, recently interviewed the medical director of this BC/BS community initiative, Brian D. Justice, DC.8)

The fallout from embracing the PSP role will be that the entire chiropractic profession will benefit from the gained public trust. Chiropractors are perfectly suited to become PSPs, and long-overdue opportunities for professional growth and expansion are now possible because of this new role.


  1. Primary Spine Provider Network. Dr. Ventura is co-owner of PSPN, which conducted the primary spine care training program in conjunction with Blue Cross / Blue Shield.
  2. Deyo RA, et al. Overtreating chronic back pain: time to back off? J Am Board Fam Med, 2009;22(1):62-68.
  3. Mafi JN, et al. Worsening trends in the management and treatment of back pain. JAMA Intern Med, 2013;173(17):1573-81.
  4. Martin BI, et al. Expenditures and health status among adults with back and neck problems. JAMA, 2008;299(6):656- 64.
  5. Dagenais S, et al. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J, 2008;8:8-20.
  6. Murphy D, et al. The establishment of a primary spine practitioner and its benefits to healthcare reform in the United States. Chiropractic and Manual Therapies, 2011;19(17).
  7. Gallop Poll 2012: Nov. 26-29, 2012; update of the perceived honesty and ethical standards of professions.
  8. Miller L. "Spine Care Delivery Model: A Payer's Perspective From Dr. Brian Justice of Excellus Blue Cross Blue Shield." Becker's Spine Review, Oct. 10, 2013.

Dr. John Ventura has more than 30 years of clinical practice experience, for the past 22 years as co-owner of a five-doctor practice. He served 15 years as a clinical instructor in family medicine at the University of Rochester School of Medicine and associate clinical professor at New York Chiropractic College. Dr. Ventura participated with the NCQA Back Pain Recognition Program pilot project, has NCQA recognized status and has worked with a large HMO plan to implement NCQA BPRP for its chiropractic providers. He is co-owner of Spine Care Partners, LLC, and Primary Spine Provider Network, LLC.

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