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Orange County Chiropractic District
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Memorandum
to: ACA Board of Governors, House of Delegates and other interested parties In this report: 1. BLUES
UPDATE/ FEDERAL PLAN BLUES UPDATE/FEDERAL PLAN As we have reported previously our Lawsuit against Trigon Blue Cross/Shield continues. A court scheduling conference was held in Abingdon, VA on September 10, 2001. The trial will commence on November 11,2002. Both sides are now identifying potential witnesses and collecting all documents that may be subject to discovery. Our lawsuit against National Blue Cross/Shield was suspended while ACA continues its discussions with the national Blue Cross/Blue Shield Association through Dr Alan Korn, senior vice president of the clinical affairs and chief medical officer, to establish a new framework by which individual state problems can be addressed. The implementation of a
new chiropractic benefit in the BC/BS Federal Employee Benefit Program was
another factor in ACA's agreement to suspend its action against the national
Blue Cross/Blue Shield plan, which covers more than 4 million federal employees
nationwide. We learned Friday that effective January 1st a new chiropractic
benefit would be included in a blue cross/shield federal plan available to
federal employees. This is the good news; the bad news is, first and foremost,
that the plan doesn't treat chiropractors as primary care doctors, contrary to
what we had been lead to believe; that the so-called benefit is available only
under the "basic plan" option and not the "Standard Plan"
option; and that the coverage is limited under that Basic Option plan to only
twenty manipulations of the spine with a co-payment of $20, a co payment that
frequently wipes out the benefit all together. We had
attempted to learn of the benefit and lend our point of view to its development
prior to Friday's meeting. National Blue Cross/Shield cited privacy concerns and
resisted our inquiries, even though we cited legal precedent to them that their
concerns were baseless. They did provide us with an opportunity to suggest what
we thought the plan should include. Obviously,
what came out wasn't what we recommended. We need
to decide what to do next. There has been some progress in our discussions with
the Blues and their medical director continues to make an effort to improve our
relationships, as noted in the stories below. But talk is cheap and this federal
plan appears to signal to us that the National Blues continue to have an anti
chiropractic agenda, notwithstanding the medical directors actions. When we
suspended the lawsuit we did it without prejudice, allowing us to reactivate it
if we felt the need. We may be close to that decision. The Board will be
consulting with Mr. McAndrews and others and together with the other plaintiffs
in the case will decide our future course of action. BLUE CROSS/BLUE SHIELD MEDICAL DIRECTOR SPEAKS AT HOD Dr. Allan Korn, chief medical officer of the national Blue Cross/Blue Shield Association, spoke to the House of Delegates to assure them that his organization is taking ACA's concerns seriously. "There is a willingness to put these issues on the table and talk through them," Dr. Korn stated. Some of the ways in which the national Blue Cross/Blue Shield Association will improve understanding and build trust with the ACA is by allowing chiropractic liaisons to work with local Blue Cross/Blue Shield plans to educate them about the chiropractic health care model. As Dr. Korn explained, local Blue Cross/ Blue Shield plans need help from chiropractors to meet their business obligations. "We do care because our patients want access to your services" He
did indicate that the discussions that he is holding with us are also going on
with the AMA, Society of Internal Medicine, American Academy of Pediatrics,
American Academy of Family Physicians, etc. BLUE CROSS/BLUE SHIELD MEDICAL DIRECTOR INVITES ACA'S PARTICIPATION ON MEDICAL ADVISORY PANEL Dr Korn invited ACA
Governor Dr George McClelland to
attend a dinner at his home along
with members of the Medical Advisory Panel, and to attend their meeting the next
day. MAP is
the advisory council to Blue Cross/Blue Shield and their 44 plans that evaluates
new diagnostic or therapeutic interventions based on their scientific merit, and
advises Blue Cross as to their appropriateness for funding. The MAP is a
consensus process that is made up of approximately 20 MD, PHD, MS types. The TEC
has the responsibility of gathering all the data on a new intervention,
developing a report for presentation to the MAP along with recommendations to
the MAP based on the established criteria that the TEC and MAP have developed in
order for an intervention to be acceptable. While we
have established a technical assessment panel, Dr. McClelland recommends that
some major changes be made. ACA HONORS ITS OUTSTANDING PRACTITIONERS At
its annual meeting, the ACA presented its major awards to a number of doctors
for their outstanding contributions to the profession. Included were the following:
MARK YOUR CALENDAR FOR NCLC Before
you know it, the ACA's National Chiropractic Legislative Conference will be upon
us. MEDICARE REIMBURSEMENT AFFECTED BY ACA ACTION During
a recent meeting with the HHS Inspector General's office, we were given some
statistics regarding chiropractic usage in Medicare that were interesting.
No one can be satisfied with the way this profession is treated under
Medicare, further necessitating the passage of the Watkins Bill. Equally
significant was the effect of our legislation eliminating the x-ray requirement
under Medicare that became effective in January 2000. ACA COMMENTS ON AFFINITY PROGRAMS The
White House Commission on Complementary and Alternative Medicine Policy is
scheduled to meet from October 4-6 to discuss the development of its report to
Congress. ACA WORKS TO IMPROVE SITUATION IN NEW JERSEY FOR OUR DOCTORS ACA's delegate to New Jersey, Frank Stiso, DC, held a heart-to-heart
meeting with Aetna officials in New Jersey on September 13 in which he laid out
the long-standing concerns about discriminatory reimbursement practices toward
the profession. SUPPORT FOOT LEVELERS Earn CEUs and protect
chiropractic with the new license renewal seminar series, "Seminars in
Support," sponsored by Foot Levelers, Inc. This new series was created to
help fund the legal action taken against the Health Care Financing
Administration (HCFA) and Trigon Blue Cross/ Blue Shield of Virginia. Speakers and Topics - "Implementation of Outcomes Assessment Case Management in the Chiropractic Practice" - Kim D. Christensen, DC, CCSP, DACRB "An
Outcomes Based Approach To The Chiropractic Practice" - ACA MEMBERS IN SOUTHERN CALIFORNIA ELIGIBLE FOR MAJOR AUTO DISCOUNT The Automobile Club of Southern California notified us that they were
making available to our members an additional 14% discount on auto insurance
through the Auto Club. If you
are a member in that area and are interested, please call Grady Locklear, sales
agent, Automobile Club of Southern California (310-914-2559). |
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