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 state organization and corporate supporters are at it again along with the Congress of Chiropractic State Associations and the Association of Chiropractic Colleges. 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 the subluxation mandate from Medicare. So much for the SOS buttons.
It's one thing that the ACA is doing this - its quite another that COCSA and the schools are endorsing it.
Those schools include: LIFE University, LIFE West College of Chiropractic, Cleveland and Palmer - all schools that claim (now a false claim) to "defend" vertebral subluxation management.
Sherman College of Chiropractic is not a member of the Association of Chiropractic Colleges and has not endorsed the scope expanding bill.
Many states within COCSA purport to protect and defend the management of vertebral subluxation - not any more.
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 Bill being lobbied by the ACA, COCSA and the Chiropractic Colleges will 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.
The ACA Bill, if passed, will forever change chiropractic. Anything covered by Medicare that is permitted under state law will be fair game. Overutilization will explode. Practice management companies will teach how to game the system. Medicare will retaliate with caps, increased allegations of fraud and medically unnecessary claims.
Worse, there will be no way to opt out.
If the standard of care becomes anything legal in your state, you will either have to do it or be responsible for referring it out.
Chiropractic will become a subset of medicine rather than a separate and distinct discipline.
The Foundation for Vertebral Subluxation is the only chiropractic organization that has come out publicly in opposition to the Bill. The following is a copy of their statement:
FOR IMMEDIATE RELEASE
August 19, 2019
Foundation for Vertebral Subluxation Opposed to ACA's Medicare Scope Expansion Bill
The chiropractic profession fought long and hard to become a recognized provider within Medicare and that recognition was based on the clinical management of vertebral subluxation. We can now say that correction of subluxation of the spine is the only covered service for chiropractors under Medicare. This was once a useful retort to Subluxation Deniers.
The lack of parity the profession should be concerned about is the inability to opt out, lack of coverage for subluxation assessment, and freedom from arbitrary caps.
We need legislation that allows chiropractors to practice as chiropractors and be reimbursed for providing the chiropractic benefit as opposed to legislation that effectively expands the scope to full physician status and removes the requirement for managing vertebral subluxation. Such efforts are clearly meant to expand the definition of chiropractic, expand the scope - which would include drugs- allow for duplication of services, position chiropractors as primary care providers instead of portal of entry, and change the very nature of the profession.
The Foundation for Vertebral Subluxation proposes that the Medicare Act be amended to provide for coverage of the assessment and care of vertebral subluxations without the requirement that a beneficiary has a concomitant musculoskeletal condition. The amendment should also provide for objective assessment of vertebral subluxation, prohibit the use of arbitrary caps, and include coverage for examinations, imaging studies, and the use of specialized instrumentation to evaluate vertebral subluxation and how it affects the beneficiary's general health. For those who do not wish to participate in Medicare, the provision of opting out must be included.
In short, the Foundation for Vertebral Subluxation opposes the ACA's dangerous scope expansion bill and endorses legislative language for Medicare that would allow chiropractors to be paid for exams, x-rays, the adjustment, instrumentation and other diagnostic services and add the ability for chiropractors to opt out of Medicare.
The Foundation encourages other organizations that purport to be dedicated to the founding principles of the profession to oppose the ACA's anti-subluxation and pro-drug Bill and endorse legislative language consistent with the modern day practice of managing vertebral subluxation.
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ABOUT Foundation for Vertebral Subluxation
The mission of the Foundation is to advocate for and advance the founding principles and tenets of the chiropractic profession in the area of vertebral subluxation through research, education, policy and service.
