Medicare Language Must Retain Unique Lexicon & Services of Chiropractic Profession
Recent efforts by the Summit Group, led by the American Chiropractic Association (ACA), seek to position chiropractors with full physician status, expand scope and remove mention of vertebral subluxation from the legislative language of Medicare.
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The Chiropractic Summit Group’s Steering Committee is made up of:
- American Chiropractic Association (ACA)
- International Chiropractors Association (ICA)
- Congress of Chiropractic State Organizations (COCSA)
- Association of Chiropractic Colleges (ACC)
- National Board of Chiropractic Examiners (NBCE)
- Federation of Chiropractic Licensing Boards (FCLB)
- Council on Chiropractic Education (CCE)
Not wanting to be caught supporting full physician status, expanded scope or removal of subluxation from Medicare, the International Chiropractor’s Association (ICA) has developed their own petition in an effort to “end discrimination in Medicare”.
Chiropractors are being expected to endorse something which does not yet exist. Will the ICA keep subluxation in but propose expanding the scope of services under Medicare to include anything allowable by state law? This is exactly what the ACA and the rest of the Chiropractic Cartel wants.
Over a decade ago the International Federation of Chiropractors and Organizations (IFCO) participated in the development and promotion of the Chiropractic Medicare Freedom and Benefit Protection Act, along with a coalition of other organizations including the WCA and the ICA. The centerpiece of this Act was a revolutionary bill (HR 2560) that would have provided a definition of chiropractic that actually reflects what chiropractic has always been and what it should always be.
The Bill was written by legislative staff from Representative Don Manzullo’s office, in collaboration with Christopher Kent DC, JD, President of the Foundation for Vertebral Subluxation and Board Member of the IFCO.
The bill's purpose was to prevent duplication of services between chiropractors and medical doctors. Contrary to what many in the profession such as the ACA and Summit Group want, not all chiropractors aspire to be medical doctors. Chiropractors have a unique role to play in the health care system – correcting subluxations -- and we are the only ones trained to do that.
According to Christopher Kent, DC, JD, HR 2560 “…did not seek to expand chiropractic practice to include a duplication of services already offered by other providers." Rather than establish a new chiropractic program, such as is currently being recommended by the ACA, ICA and the Summit Group, HR 2560 would have established a separate chiropractic category. "The bill sought to rectify the errors made in the original Medicare statute including chiropractic care," Kent explained. "A significant error in this legislation was classifying D.C.s as limited scope physicians. Thus, the chiropractic benefit was characterized as a physician service, permitting medical doctors and osteopaths to provide what is purportedly a chiropractic benefit."
Here is the language related to subluxation in HR 2560:
(B) For purposes of subparagraph (A), care is clinically necessary when examination by a chiropractor demonstrates objective evidence of a subluxation. Such examination may include—
(i) physical examination;
(ii) radiological examination; and
(iii) specialized diagnostic instruments used in the practice of chiropractic.
(C) For purposes of subparagraph (A), the term ‘subluxation’ means a complex of any or all of the following articular changes that compromise neural integrity and may influence organ system function and general health:
(i) Functional.
(ii) Structural.
(iii) Pathological.
HR 2560 came incredibly close to actually passing. Senator Orrin Hatch had asked Senator Grassley to substitute HR 2560 for a demonstration project to expand scope of practice under Medicare that the ACA had submitted. This obviously made the ACA and the rest of the Chiropractic Cartel very angry.
According to ACA leader at the time, James Edwards DC in a letter to the ACA House of Delegates, the ACA was in “shock and awe” that HR 2560 actually had a chance for passage.
That is how close it came.
Edwards and the ACA then embarked on a disinformation campaign to discredit the organizations and individuals involved in HR 2560 in an effort to kill the bill. This included inflating the ACA’s membership numbers to Orrin Hatch and downplaying the membership numbers of the other organizations involved during an emergency meeting Edwards requested with Hatch’s staff.
Edwards was accompanied to this meeting by the lobbyist for the Association of Chiropractic Colleges (ACC).
They told Hatch’s staff that “The loss of physician status under Medicare would be very harmful to the profession.” They told them that the only reason this bill was being pushed was so DC’s would not be considered physicians and then would have no responsibility to diagnose or refer “since they were only correcting subluxations.” Edwards asserted that “what was being proposed was a public safety issue” and it needed to be stopped.
Edwards provided Hatch’s staff with letters from the Association of Chiropractic Colleges and the National Association of Chiropractic Attorneys opposing the legislation.
In a letter to the ACA House of Delegates Edwards stated:
“This bill is the most dangerous bill I have seen introduced at the state or federal level in 26 years of practice and it has grown ‘legs.’ In one quick swipe, this harmful provision could devastate chiropractic by delegating us to mid level practitioners and drastically cutting our reimbursement levels.”
Due to the efforts of the ACA, ACC, NACA and others, the bill died.
Jim Edwards eventually resigned from the ACA and joined the ICA becoming a Representative Assemblyman in Texas. He shortly resigned that position and is now employed by The Joint and markets decompression services to chiropractors.
The Bill included language that would have allowed chiropractors to be paid for exams, x-rays, the adjustment, instrumentation and other diagnostic services. The only other thing to add would be the ability to opt out of Medicare but the likelihood of that happening is near zero.
This is the Medicare legislation that’s needed now.
Not what the ACA and Summit group are proposing.
We need legislation that allows chiropractors to practice as chiropractors and be reimbursed for providing the chiropractic benefit as opposed to legislation that expands the scope to full physician status. Such efforts are clearly meant to expand the definition of chiropractic, expand the scope, allow for duplication of services, position chiropractors as primary care providers instead of portal of entry, and change the very nature of the profession.
With full physician status in Medicare the Chiropractic Cartel will use that victory to further expand the scope to include all related diagnostic and treatment modalities allowed by state scope including prescription drug rights.
The contention that chiropractors are trained and educated as primary care physicians has been promoted by several organized groups, organizations, and trade associations within chiropractic.
The Chiropractic Cartel includes mostly members of the so-called “Chiropractic Summit” group which has as one of its goals the establishment of chiropractic as the practice of primary care as chiropractic physicians.
