The chiropractic field has been afflicted by multiple challenges related to intramural battles over philosophy, practice, scope, and even language. The tip of the iceberg is actually a double fin: the integration oriented American Chiropractic Association (ACA), with nearly 15,000 members, and the more fundamentalist International Chiropractic Association (ICA), which is just 20% of the size of the ACA. Earlier this spring, the two organizations joined together as part of the Chiropractic Summit to back a campaign to end chiropractic discrimination in Medicare.
The press release following the April 28, 2016 gathering boasted: “Chiropractic Summit Unanimously Supports National Medicare Reform Initiative to Eliminate Discrimination.”
Medicare has covered chiropractic care for over 4 decades. At issue is what the release calls “a blatantly anti-competitive provision of Medicare law that arbitrarily limits reimbursement for medically necessary services delivered by doctors of chiropractic (DCs).” From a patient-centered framework, the action of the Summit participants was to “help to grow public support to help eliminate discrimination faced by chiropractic patients in Medicare.”
The vehicle for the campaign is the National Medicare Equality Petition, developed by the ACA. According to their website, success “would allow doctors of chiropractic (DC) to perform to the fullest scope of their license in Medicare.”
Based on current Medicare wording, “Medicare Part B covers manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.” Notably, the coverage does not extend to include the evaluation and management (E & M) that is required of chiropractors prior to treating patients.
“It’s time that we finally level the playing field when it comes to Medicare reimbursement and remove the barriers that our patients face. To accomplish this goal, it’s going to require a strong, coordinated effort by all major players in this profession,” stated the Summit Chairman, Lewis Bazakos, DC (pictured left).
First convened in September 2007, the Chiropractic Summit meets regularly “to collaborate, seek solutions and support collective action to address challenges with the common goal of advancing chiropractic.”
Comment: The website of the Chiropractic Summit advertises that it is about “one voice” for the field. Highlighting “one voice” in chiropractic care is like regular medicine highlighting “evidence-based.” The language selected makes it clear, in both cases, that the thing celebrated is not typically par for the course.
That said, I’ll throw my own voice into this unity, if for no other reason than to protest the insanity of not paying chiropractors for E & M. Has anyone in the Medicare wheelhouse ever put two and two together: Let’s see, we know people do what they get paid for, so how about we set up an incentive structure so that we support chiropractors failing to fully evaluate their patients before providing the manipulative services for which we pay them? Isn’t Medicare supposed to be interested in patient safety and, heck, why not bow to the known value of relationships and “patient-centered care” rather than “procedure-centered care”? For a field that some like to blast for “wracking and cracking” – perhaps Medicare has gotten what it wished for? Maybe it’s time we have a payment system that positively supports chiropractors’ work in evaluating their patients.
Those who would like to support the anti-discrimination campaign may add their name to the National Medicare Equality Petition by visiting www.acatoday.org/equality.