American Chiropractic Association Condemns Prepay Plans and Attempts to Force Differential Diagnosis

According to the ACA Press Release the HOD approved important policies supporting ACA’s efforts to position DCs as conservative primary care doctors who can help fill the looming primary care workforce gap. For the ACA this apparently means that conservative chiropractors who focus their practice on the management of vertebral subluxation and offer prepay plans are a threat to public health. The following is the text of the policy adopted by the ACA's HOD's:

Public Health Concerns Due to Failure to Differentially Diagnose

ACA condemns as a threat to public health the failure by doctors of chiropractic/chiropractic physicians to adequately differentially diagnose and/or to sell treatment packages in the absence of a differential diagnosis. Such practices are contrary to the doctorate level of education inferred by our degree. Furthermore, they are contrary to the universally accepted standards of care and do not represent the customary practices of a member doctor of this organization.

On plain reading of the language of the policy it becomes clear that the ACA intended for the policy to not just apply to their own membership but by referring to "universally accepted standards of care" leave all chiropractors at risk for condemnation in instances of malpractice accusations, regulatory actions and other actions taken against chiropractors where standard of care is an issue.

Most at risk however, is the chiropractor who is a dues paying member of the ACA and offers prepay to their patients. Questions have arisen regarding several practice management companies that promote prepay and market to ACA members and how their clients will be affected by this new policy.

The ACA does not reference what standard of care guidelines it is referring to in regards to "universally accepted standards of care." Nor is the ACA Policy explicit regarding the extent of differential diagnosis necessary to meet their arbitrary standard.

For example, most chiropractors who practice conservative, traditional care focused on the management of vertebral subluxation limit their care to the vertebral subluxation and do not attempt to diagnosis diseases, disorders or syndromes beyond this. Instead, the subluxation centered chiropractor makes note of unusual findings and recommends the patient seek diagnosis and treatment of other conditions by an appropriate medical physician.

Such practices are consistent with published policy statements such as those from the Foundation for Vertebral Subluxation and the International Federation of Chiropractors and Organizations.

The adoption of such an extreme policy by an organization such as the ACA that represents only a small fraction of the profession (an estimated 6000 full dues paying members versus 70,000 practicing chiropractors) is thought to reflect the ACA's attempts to position chiropractors as primary care providers who can diagnose and treat a broad spectrum of human ailments despite the fact that chiropractors are not trained at the same level as medical physicians to administer such care.

The ACA's move is in concert with other related policy and political actions within the profession by a group broadly known as the Chiropractic Cartel. This Cartel has seized control of the educational and regulatory aspects of the profession in calculated moves in an effort to expand chiropractic's diagnostic and treatment scope, including the addition of pharmaceuticals.

Most conservative chiropractors hold that it is their responsibility to determine if a patient is presenting with a vertebral subluxation amenable to chiropractic care or if there is some other condition that requires medical care and referral.

This new policy obstensibly attempts to force all chiropractors into practicing as medical physicians and characterizes those that don't as a threat to public health. Making matters worse is the added condemnation within the policy that prepay plans based on a diagnosis of vertebral subluxation or even wellness plans where families routinely visit chiropractors for spinal checkups in the absence of disease are now considered in violation of an unnamed and unreferenced standard of care.

Chiropractors are urged to check their state's scope of practice and their board's policies, rules and regulations in regards to diagnosis and financial arrangements making sure they are practicing in accordance with those state guidelines as opposed to the ACA's policy. ACA members are especially urged to review these guidelines and give them thoughtful consideration considering the implications from the perspective of malpractice and regulatory proceedings. Plaintiff's attorney's will no doubt seize on this policy in those cases where the defendent is an ACA member and has not complied with the policy.

Chiropractors who are members of other trade organizations are likewise urged to consult their organizations policies concerning diagnosis and pre-pay plans.