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Orange County Chiropractic District
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Memorandum to: ACA Members, ACA Board of Governors,
House of Delegates and Other Interested Parties In this report: 1. ACA RESPONDS TO TRIGON ALLEGATIONS 2. NATIONAL CHIROPRACTIC LEGISLATIVE CONFERENCE 2002 3. CMS CHANGES POSITION REGARDING UTILIZATION PARAMETERS 4. HHS SECRETARY WANTS TO ELIMINATE UNREASONABLE REGULATIONS 5. GIFT FROM THE HEART: FCER'S PATIENT APPRECIATION DAY 6. CONGRESSIONAL BATTLEGROUNDS FOR 2002 7. UPI AND MSNBC.COM COVER CHIROPRACTIC ISSUES 8. ACA MONITORS "ALLY MCBEAL" BROADCAST (PT. 1) 9. ACA MONITORS "ALLY MCBEAL" BROADCAST (PT. 2) ACA RESPONDS TO TRIGON ALLEGATIONS You will recall from my previous reports the startling admission made several weeks ago by Trigon Blue Cross/Blue Shield that it pays chiropractic doctors less for the same services provided by medical doctors because "the medical doctor has a higher degree of education, expertise, training, skill and medical knowledge." ACA's legal team is zeroing in on that pivotal comment in a set of interrogatories filed with the court and delivered to Trigon on December 21. ACA first identifies a laundry list of studies and reports detailing the effectiveness of chiropractic care and the superiority of chiropractic education and training in a variety of areas. In interrogatory #10, the ACA directs Trigon to identify: (1) each CPT code and condition which Trigon contends its "higher degree" admission applies, (2) the persons and sources consulted and relied upon by Trigon in making its decision regarding the relative qualifications for each of these CPT codes and conditions, (3) just what portion of a medical doctor's education, expertise, training, skill and medical knowledge better qualifies him or her to treat those identified conditions, (4) any study or other information that would lead to the conclusion that any of the reports identified by the ACA on chiropractic effectiveness and education are no longer accurate or otherwise in error. The battle lines are being drawn on this central issue of reimbursement discrimination that cuts far beyond this one plan alone. I noted in my report from last week the strong editorial by Dynamic Chiropractic to our lawsuit against Trigon. I understand that the link I cited to the full editorial was incorrect. Here is the correct link http://www.chiroweb.com/archives/20/01/14.html. The editorial is really worth reading! NATIONAL CHIROPRACTIC LEGISLATIVE CONFERENCE 2002 Help push the legislative initiatives of the ACA and respond to the outlandish comments by our opposition by attending our annual legislative conference scheduled for March 6-9, 2002, at the Hyatt Regency Hotel Capitol Hill in Washington D.C. This is the opportunity for the profession to focus their D.C. power over a three-day period. Members of Congress do notice this level of participation as one of the measures of an organization's political strength and commitment. They recognize the cost and commitment that is required by members to attend and are particularly impressed when a member from their district comes by to discuss legislation. But NCLC is more than just an opportunity to promote our agenda and oppose the opposition's agenda. It also offers numerous programs that are useful to doctors back in their respective states. This year will be no exception, with seminars on hospital privileges and HIPPA, marketing, VA and DOD implementation and much more. For a tentative schedule for NCLC, click: http://www.acatoday.com/about_aca/meetings.html CMS CHANGES POSITION REGARDING UTILIZATION PARAMETERS In a major development, Medicare carriers will no longer be permitted to issue "blanket denials of services that exceed utilization parameters, under a new rules published by the Center for Medicare and Medicaid Services (formerly HCFA). Under the new rule that becomes effective on April 1st, Medicare carriers are prohibited from denying claims that reach a certain utilization review parameter unless: 1) clear policy serves as the basis for the denial; 2) the denial is based on medical impossibility; 3) the carrier sent an additional documentation request (ADR) letter and reviewed the ADR response, but the ADR response failed to support the coverage or coding of the claim, or 4) no timely response was received in response to an ADR letter. In addition, the new rule allows carriers to release utilization guidelines which should be helpful to doctors of chiropractic in determining when a carrier will deem a service "not reasonable and necessary". While this new policy is a positive development for the chiropractic profession, it is now even more important for doctors of chiropractic to ensure that their documentation is strong enough to withstand a complex medical review. We will be providing additional information as this develops. We have for years been pushing HCFA to require that their carriers be more open regarding their decision-making process. This is a step in the right direction, but with it comes some responsibility on our part. HHS SECRETARY WANTS TO ELIMINATE UNREASONABLE REGULATIONS As part of a Department of Health and Human Services-wide initiative to reduce regulatory burdens in health care, HHS Secretary Tommy Thompson has requested public input on ways to reduce current burdens imposed by existing HHS regulations. The comments are due to the Secretary by March 5, 2002. The ACA is preparing comments that address our overall concern that the Medicare Part B regulations are an overly strict interpretation of the Medicare statute. GIFT FROM THE HEART: FCER'S PATIENT APPRECIATION DAY This Valentine's Day, you can help raise funds for vital chiropractic research while building your patient base by participating in FCER's Patient Appreciation Day program. The ACA Board of Governors has endorsed the program and is urging doctors of chiropractic across the country to band together in support of this event on February 14, 2002. On Patient Appreciation Day, you contribute your services in exchange for patient contributions to FCER. Patients will make a contribution to FCER of either $15 or one-half your usual treatment fee. (Worker's compensation and insurance payments cannot be accepted on your Patient Appreciation Day.) For more information about the Patient Appreciation Day program - or to receive a free kit to help you plan and promote the program -- call FCER toll-free at 800-622-6309. The kit may also be downloaded from FCER's Web site at www.fcer.org, but the posters and free brochures must still be ordered via telephone. CONGRESSIONAL BATTLEGROUNDS FOR 2002 This is going to be an interesting year in politics as both parties try to regain control of their respective Houses without appearing to undermine the efforts to fight terrorism. The Democrats control the Senate by a razor-thin margin of one vote, while the Republicans control the House by a slim five votes. Anything can happen, and the outcome could shift the direction of this country. The stakes are high and we want to be part of the action. From time to time in my report I will discuss some of the key races that the ACA-PAC is watching and may participate in. These articles will be non-partisan (yes, I can be non-partisan) and will not indicate which way the PAC is leaning on the race. If I did, this would be construed as an in-kind contribution. It was made official last week - Reps. Johnson and Maloney will fight it out for Connecticut's 5th district. The compromise is that Maloney gets an additional 13,000 registered Democrats in the new district. But, 55% of the new district is in Johnson's current district. This has set it up to be a very tight race, with both sides saying they have an advantage. The compromise was necessary when the results of the census report conducted in 2000 caused the state of Connecticut to lose one representative in the House. Two incumbents running in the same district is a nightmare for most political organizations, and this will be a particularly tough one for the ACA-PAC to decide on. Rep. Maloney has been a longtime friend of chiropractic, and recently received the Connecticut Chiropractic Association's "Legislator of the Year" award. Johnson, who is Chair of the important Ways and Means Health subcommittee has said that "a campaign contribution for Jim Maloney is a contribution against Nancy Johnson." She has also cosponsored some of our legislation. The PAC will continue to monitor this tight race. UPI AND MSNBC.COM COVER CHIROPRACTIC ISSUES ACA's media relations staff was successful in arranging interviews with MSNBC.com and United Press International (UPI) in December. Dr. Steven Conway, president of ACA's Council on Occupational Health, was interviewed for a story on computer ergonomics for children that was posted on MSNBC.com on December 5. Click here for a link to the story, titled "Keyboarding Kids: Generation at Risk?" http://www.msnbc.com/news/610811.asp In addition, ACA's national spokesperson, Dr. Jerome McAndrews, participated in two interviews with United Press International wire service in December. The first interview focused on a recent Ohio State University study on recurring back injury, and the story crossed the UPI wire on December 1. Click here for a link to the story, titled "Misused Muscles Key to Repeat Back Injury." http://www.upi.com/view.cfm?StoryID=30112001-120202-5014r In late December, Dr. McAndrews interviewed with UPI once again - this time on the topic of preventing winter-related injuries. This holiday feature was released December 26. Click here for a link to the story, titled, "Injury Prevention Makes Holidays Happier." http://www.upi.com/view.cfm?StoryID=19122001-125922-5483r ACA MONITORING ALLY MCBEAL BROADCAST (PT. 1) The ACA sent the following message via email to its membership prior to the airing of the January 14 episode of "Ally McBeal." In response to a potential attack on the chiropractic profession by Fox Broadcasting Company's "Ally McBeal" television program, American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC) staff members have discussed the episode of concern with officials from the program. Earlier this week, Fox aired a promotional piece for the upcoming episode, set to air at 9:00pm Eastern time on Monday, January 14, in which the lead character refers to chiropractors as "quacks." As a result of the discussions with Fox officials, ACC executive director David O'Bryon learned from Fox's legal counsel that the slur against chiropractic is followed by the lead character receiving chiropractic care and having a beneficial experience. As a result, she refers several other characters to her doctor of chiropractic. In addition, another Fox official indicated to Patrick Bernat, ACA's public and media relations manager, that, "because of the quirky nature of the show, the situation could likely be spun into a positive" for chiropractic. Obviously, there is no guarantee that what Fox considers to be positive for the chiropractic profession will agree with what we believe to be positive for the chiropractic profession. Thus, the ACA and ACC will be monitoring the program closely, poised to respond aggressively if deemed necessary. Should such action be deemed necessary, the ACA and ACC will consider any and all legal or public relations responses that may be appropriate. ACA MONITORING ALLY MCBEAL BROADCAST (PT. 2) After viewing the Monday, January 14 episode of the Fox Broadcasting Company's "Ally McBeal" television program, the ACA has decided it is unnecessary to respond aggressively to Fox regarding the episode's chiropractic theme. We had notified our membership via email that, because of a promo for the show that aired the previous week containing a negative reference to chiropractic, we would be monitoring the broadcast to determine whether or not any form of response would be appropriate. True to the quirky and comedic nature of the show, the chiropractic scenario weaved into the episode's plot was so silly and absurd that ACA would likely come across as defensive and lacking a sense of humor if we responded too harshly. We will, however, be contacting the producers of the program to encourage them to continue to incorporate positive - and realistic - stories about chiropractic in future episodes - a topic on which the ACA would be pleased to provide reliable information. |
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