Complete Story
04/28/2026
THE QUIET RESTRICTION ON CHIROPRACTIC CARE – BUNDLING’S EFFECT ON PATIENT OUTCOMES
By: Renee Haberl, DC Reimbursement Committee Member
Most chiropractors go into practice with a clear goal:
give the right care, at the right time, for the patient in front of them.
But in many third-party administrator (TPA) systems, that goal is being limited by one thing: bundling.
Bundling groups services into a single payment. In theory, it can improve efficiency.
In practice—especially in chiropractic—it often doesn’t fit how patients actually present.
Chiropractic care is not one-size-fits-all.
Patients range from simple, short-term cases to complex conditions involving chronic pain, functional loss, and multiple health issues.
Yet many systems apply one bundle to all patients.
That’s like paying the same amount for every surgery—whether it’s a toenail removal or a heart procedure.
Where the Problem Starts:
The issue is not bundling itself.
The issue is the lack of clinical stratification.
Most bundles are built around low-complexity patients.
If a patient needs more care, doctors can technically provide it—but often won’t be reimbursed for it.
This creates a real problem:
- Care that should be delivered is financially discouraged
- Clinical decisions are influenced by payment limits
- Providers are forced to absorb costs or reduce care
What This Means for Patients:
For more complex patients, chiropractic care is not optional.
It helps them:
- Maintain mobility
- Control pain
- Avoid more aggressive treatments
When care is limited by reimbursement:
- Treatment may stop too early
- Function can decline
- Pain persists or worsens
- Patients are pushed toward medications, injections, or surgery
This isn’t just about one visit—it changes the patient’s long-term trajectory.
Patients who could be managed conservatively may end up in higher-risk, higher-cost care pathways.
What This Means for Providers:
Over time, this creates pressure:
- Provide less care than clinically needed
- Or provide appropriate care without being paid
Neither is sustainable.
It also affects access.
If providers can’t sustain participation:
- Networks shrink
- Access becomes more limited
- Vulnerable patients are affected the most
What This Means for Payers:
This model creates multiple risks:
- Clinical risk: patients don’t receive appropriate care
- Utilization risk: under-treatment leads to more downstream care
- Compliance risk: potential conflicts with medical necessity standards
- Network risk: fewer providers available
And importantly—these outcomes are predictable.
A Better Approach:
Bundling can work—but only if it reflects real clinical practice.
That means:
- Stratifying patients by complexity
- Using tiered or risk-adjusted bundles
- Allowing meaningful exceptions when needed
- Aligning payment with expected care intensity
The Bottom Line:
This is an alignment issue.
If reimbursement doesn’t support appropriate care,
patients will not consistently receive it.
When payment dictates care:
- Treatment is limited
- Outcomes suffer
- Costs increase over time
Bundling, in this form, is no longer just a payment model.
It becomes a deciding factor in whether patients get the care they need.
Payment models should support clinical judgment—not override it.
The AAC Reimbursement Fairness Committee is actively working to address these issues.
