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Orange County Chiropractic District
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Memorandum to: ACA Members, Board of Governors, House of
Delegates and Other Interested Parties This week's report includes the following items: 1. COURT ORDERS TRIGON TO PROVIDE CRITICAL INFORMATION: ANOTHER ROUND FOR ACA 2. LAWSUITS: VICTORIES COME WITH A PRICE 3. THANKS TO THOSE HAVE CONTRIBUTED 4. ACA ASSISTS KENTUCKY ASSOCIATION 5. BLUE CCHIP PROGRAM AT NCLC 6. ANNUAL MEETING JUST AROUND THE CORNER 7. HIPAA INFORMATION 8. VA INFORMATION 9. ACA GOVERNOR APPOINTED TO STATE BOARD AND OTHER SUCCESSES 1. COURT ORDERS TRIGON TO PROVIDE CRITICAL INFORMATION: ANOTHER ROUND FOR ACA On February 7, 2002, we requested that the court compel Trigon to answer our following interrogatories: 9(b), 9(c), 10, 11 and 12. Interrogatories. 9(b), 9(c) and 10 relate to the comparative educations and training of chiropractors and medical doctors, recently put at issue in the case by Trigon. Interrogatories 11 and 12 relate to Trigon's determination of the comparative amounts of reimbursement allowed for chiropractic doctors and medical doctors under the applicable CPT codes. In an opinion dated March 18, 2002, Judge Jones ordered Trigon to answer, by April 8, 2002, interrogatories 9(b) and 9 (c), which read as follows: 9(b): "Identify every market survey, study, analysis, and/or other information on which the applicable defendants rely as supporting or tending to support the amounts of payments to chiropractors, the amounts of payments to medical doctors, or both." 9(c): "Identify every medical doctor who consulted, was in any way involved with, or in any way participated in any decision and/or policy to pay chiropractors less than medical doctors for procedures billed under the same CPT code." While Judge Jones did not compel Trigon to answer interrogatory 10, which seeks information from Trigon concerning nine studies on the superior training of chiropractic doctors, his order makes it clear that Trigon's answer to interrogatory no. 9(b) should address the information requested by interrogatory no. 10. Thus Trigon will be forced to disclose any competing studies or state that they do not have any. As Judge Jones stated in his opinion: "Interrogatory ten quotes from nine studies purporting to show that doctors of chiropractic are more effective and have more training than medical doctors in treating the musculoskeletal system. The interrogatory then asks Trigon, in light of these studies, to provide any studies or information that it relied upon in making its decision to pay doctors of chiropractic differently than medical doctors for the same services performed. Good cause does not exist for this interrogatory (no. 10). Interrogatories six, seven, eight and nine request similar information. In particular, interrogatory numbered 9(b) requires Trigon to disclose any study and/or other information supporting greater payments to medical doctors than to doctors of chiropractic. The answer to that interrogatory ought to supply plaintiffs with any relevant information needed to prevent surprise in the preparation of the case for trial, particularly in conjunction with other discovery methods that plaintiffs may utilize." Interrogatories 11 and 12 request detailed information concerning the amounts of reimbursement, by CPT code, made by Trigon to chiropractic doctors and medical doctors. The judge found these interrogatories to be "premature at this stage of the case" because he believed that these interrogatories pertain to plaintiffs' damages. He indicated that he "may require production of information of this nature in the future." In any event, he did not preclude us from seeking this information through other discovery methods, and plaintiffs have already notified Trigon that plaintiffs will seek this information by way of an upcoming deposition of Trigon. 2. LAWSUITS: VICTORIES COME WITH A PRICE In the last two months we have enjoyed the success of the HHS department reversing its policy that had allowed physical therapists to provide the chiropractic service under Medicare, and now the decision by the court requiring Trigon to provide our requested information. The policy shift by HHS regarding physical therapists was significant. And while the decision by the judge in Trigon wasn't significant in itself, the type of information that they are now required to provide will be significant to the overall outcome of the suit. But these victories are expensive. Since the HHS suit began in 1998, followed in August 2000 by our suit against the blues, we have spent over 3 million dollars in litigation cost. Our monthly costs are now averaging $150,000 and this will not change as we enter the deposition phase of the suit against Trigon. Let's put this into perspective. We have essentially one law firm taking on the law firm of the federal government and the law firms of the blues. Trigon uses two law firms, and national Blue Cross/Blue Shield used two firms when they were in the case. We don't know the legal expenses of these firms at this point. However, we might be able to use the figures from the Wilk suit to provide some guidance. Our legal expenses in the Wilk suit were $4 million (1980 dollars), while the combined total of the opposition was $20 million. We continue to need your help as we enter the deposition stage of your lawsuit. Please visit our Web site at http://www.acatoday.com/pdf/legal_action.pdf to contribute. 3. THANKS TO THOSE HAVE CONTRIBUTED Edmund Burke once declared, "Evil triumphs when good men do nothing." There is a long list of good doctors and students who have united in our legal campaign against CMS and Trigon Blue Cross/Blue Shield. Please review the list and take the time to thank your colleagues for their invaluable support: http://www.acatoday.com/pdf/contributors.pdf 4. ACA ASSISTS KENTUCKY ASSOCIATION Two weeks ago, Tom Daly, ACA legal counsel, was contacted by the Kentucky Chiropractic Association. The KCA indicated that the state of Kentucky was attempting to limit Medicaid reimbursement for chiropractic care to manipulation only, under the rationale that to go beyond manipulation would jeopardize the federal contribution. Mr. Daly pointed out that under Medicaid manipulation is a floor, not a ceiling, and that the states were free to provide additional services at their discretion and that nothing in federal law and regulation limited chiropractic coverage to manipulation. He then spoke to KCA's attorney who requested substantiation of his comments. ACA staff put together supporting information which was faxed to their attorney that afternoon. We then learned that the proposal to limit chiropractic had been turned back based in large part on the information provided by ACA staff. Last weekend, Dr. Mark Schweitzer, ACA delegate to Kentucky, indicated that this victory was important to his state's doctors. If the position had been maintained it would have meant a substantial loss of dollars to his doctors. There was a story in the Washington Post that said the feds and states were concerned that Medicaid costs were skyrocketing and they would be looking for ways to reduce costs. State associations need to be vigilant that a similar thing would not occur in their area. Let us know if it does as we will try to assist. 5. BLUE CCHIP PROGRAM AT NCLC NCLC was truly a success. Over 350 students and doctors registered for the program. This number doesn't necessarily include a number of doctors who participated in some of the non-legislative activities scheduled over the weekend. One of these was the first conference of Blue Cross/Blue Shield liaisons. As you will recall, part of our decision to suspend the lawsuit against the national Blue Cross/Blue Shield Association was their assurance to establish an effective liaison program between representatives of the ACA and the local blues plans. This conference brought together our representatives through which we could discuss common problems and successes. It included presentations from Dr. Allan Korn, senior medical director for the national Blue Cross/Blue Shield Association, two doctors from states where substantial progress was being made with the local plans, and a former medical director of a Blue Cross/Blue Shield plan who shared some frank insights into the mindset of medical directors. Over 72 doctors participated in the conference and forty-three states were represented. 6. ANNUAL MEETING JUST AROUND THE CORNER The annual meeting of the ACA is less than six months away. The information below contains an outline of the HOD/BOG/COD meetings scheduled and deadlines for bylaws, resolutions and awards. Deadlines: · position papers are due on 6/1 · proposed bylaw revisions are due on 7/1 · proposed resolutions are due on 7/16 · Chiropractor of the Year, Humanitarian of the Year, and Delegate of the Year nominations are all due on 7/16 Hotel/scheduling information: * Location - The Fairmont Hotel, Kansas City, MO(1-800-866-5575) · Date - Aug. 28-31, 2002 · BOG Meeting - Aug. 27-28 · Committee Meetings - Aug. 28 · COD Meeting - Aug. 29 · HOD Meeting - Aug. 30-31 · Room rates: $154 single or double. · Cutoff date for discounted room reservations - Aug. 13 7. HIPAA INFORMATION We have just updated our Web site with the latest information on HIPAA. See link below. But while the information is the latest, it is certainly not the final word on HIPAA. Yesterday, HHS issued some new regulations for public comment gutting some of the provisions imposed by Clinton. In general, they appear to be loosening the report requirements. ACA will submit comments to HHS regarding the proposals. Once the revisions have been adopted we will make further changes to our Web site: http://www.acatoday.com/government/hipaa/ 8. VA INFORMATION Attached is the link for the Members Only section of our Web site that addresses implementation of the chiropractic benefit under the Veterans Administration. It is the most up-to-date information we have on the subject. http://www.acatoday.com/membersonly/government/va/implementation_benefit.shtml 9. ACA GOVERNOR APPOINTED TO STATE BOARD AND OTHER SUCCESSES Dr. Linda Zange, member of the ACA Board of Governors, had a great weekend. First, she was notified that Governor George Ryan of Illinois had just appointed her as the chiropractic representative to the Illinois Department of Professional Regulation's Medical Disciplinary Board. Then she spent a day, along with ACA delegate to Illinois, Dr. Lawrence Pyzik, promoting ACA products and activities at the convention of the Illinois Chiropractic Society. Not only did she bring in additional members and contributions to the legal action fund, but also sold over $1,900 in products. A great day for Dr. Zange and the ACA. We have placed my weekly EVP report on our Web site, where members and non-members can download the report in various formats. We will have the report available in "Publications", "EVP Report." The report is available in .html and .txt formats. |
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