Current Medicare Proposals Are Pipe Dreams

Matthew McCoy DC, MPH
Current Medicare Proposals Are Pipe Dreams

Full Scope, Primary Care and Drugs Are Real Issue

Recently, chiropractic’s role in Medicare has been put back into the spotlight. Back in the 70’s it literally took an act of Congress to get chiropractors included in Medicare. The fight was not an easy one and followed some intrigue, a massive letter writing campaign to legislators and the filling of Madison Square Garden with patients demanding chiropractors be included.

Well, we got what we wanted.

Or did we?

In the 90’s the American Chiropractic Association (ACA) launched the Save Our Subluxation (SOS) campaign. With the profession tired of watching as other providers offered the chiropractic benefit under Medicare the Chiropractic Cartel decided it would be wise to sue the United States Federal Government over this issue. They even created those little SOS buttons.

What could possibly go wrong?

Everything – it turns out. Eight million dollars later, the ACA lost that lawsuit and the decision by Judge John Garrett Penn laid out the foolishness of the ACA’s claims. Claims, which the ACA was told by other groups in the profession would not fly and which put much more at risk than we stood to gain. The saner voices suggested we go back to Congress and clarify its intent when it put chiropractic in Medicare as a service to manage vertebral subluxation.

The loss of the HCFA lawsuit was akin to losing a patent. The management of vertebral subluxation no longer belongs to chiropractic (legally speaking) and is open to anyone who wants it. Its a dirty little secret that the ACA doesn't want to talk about.

Now, years later the ACA and its organizational and corporate supporters via the Chiropractic Summit Group are at it again. This time they want to go to Congress and get them to EXPAND the scope of practice under Medicare so that everything under state scope will be covered – which of course also means drugs. 

Adding insult to injury they also think the best way to do it is to remove subluxation language from Medicare. So much for the SOS buttons. 

Worse still is that many in the subluxation camp are afraid to speak up and oppose what is being supported by virtually all of the profession's organizations, schools and leaders. They are afraid because many in the subluxation camp, while they may not admit it publicly, also want expanded scope. They may not want to prescribe drugs but they want primary care status (as opposed to portal of entry status) and they want to be paid for all the “vitalistic” services they provide such as nutrition, exercise, physical therapy etc.

The harsh reality is that: 

  • The proposals being lobbied by the ACA, ICA, ACC, COCSA and the Chiropractic Summit will all increase Medicare expenditures.
  • Their proposals are a blatantly self-serving approach. 
  • It is obvious that the focus is on chiropractors making more money by being able to bill for additional procedures, not service to patients. 
  • In the real world, chiropractors are not viewed as primary care physicians. 
  • Would you go to a chiropractor for a prostate exam or urinary tract infection? 
  • How many would want a woman in their life (think wife/daughter) go to a chiropractor for a breast or pelvic exam? 
  • How many think chiropractors are qualified to prescribe drugs?

Nevertheless, this is the plan from the “leadership” of the profession including those who purport to be on the side of subluxation.

If we are going to attempt to “reform” Medicare 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.

Be thoughtful before you sign any petition being put in front of you regarding Medicare.


Foundation for Vertebral Subluxation