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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 week's report: 1. ACA HOUSE OF DELEGATES TO CHIROPRACTIC NETWORKS
AND THIRD-PARTY PAYORS: "EVERYONE IS ACCOUNTABLE." ACA HOUSE OF DELEGATES TO CHIROPRACTIC NETWORKS AND THIRD-PARTY PAYORS: "EVERYONE IS ACCOUNTABLE." During our meetings in Chicago last year with senior medical directors of multiple Blue Cross/Shield plans throughout the country, we were told publicly and privately that if we really wanted to find the cause of the various reimbursement schemes besetting our profession, we should look inwardly toward our chiropractic networks. They claimed that these networks made offers to the Blues plans that, from a business standpoint, the Blues plans would have been foolish to reject. Some of this may be just hype or a diversion from the real culprits. And some of it may not be. In any case, the ACA's House of Delegates discussed this matter at its recent meeting in Washington, D.C., and passed the following motion: "Managed Care Practices: ACA has long been concerned over the harmful and discriminatory practices of managed care organizations - particularly chiropractic networks and third-party administrators - affecting proper patient care and the practice of chiropractic. ACA vehemently opposes these harmful and discriminatory practices associated with managed care: limiting full scope of practice; inappropriate CPT applications and reimbursement policies; use of discount/affinity programs; restrictive limits of care; improper utilization review. ACA and its leadership will communicate this position to the profession, obtain detailed data on these abuses, develop and implement a plan to halt them and give a status report on these efforts at the August 2002 House of Delegates meeting and each subsequent House of Delegates meeting." We will be providing our doctors with a form on which they can comment on their particular experiences with the managed care companies, which will become part of the record presented to the House of Delegates. As an aside, while this resolution was being discussed by ACA's House of Delegates, George McAndrews also made clear his concerns about the activities of these networks. No one can suggest that the chiropractic networks have brought about the present state of the managed care system any more than they can suggest the Blues plans have. And like the Blues plans, not all chiropractic networks are bad. But a chiropractic network that isn't operating on behalf of the chiropractic patient is no better than the Blues plan that acts in this manner, and should be held to the same standard of accountability. STATE ASSOCIATIONS CONTINUE TO SHOW STRONG SUPPORT FOR THE LAWSUITS This week, we received contributions from the following state and district associations:
I would like to take a moment to highlight the efforts of the doctors from the Ohio State Chiropractic Association and its districts. Thanks to the efforts of Drs. Rick McMichael and Dick Thompson, the Ohio organizations have contributed a total of $81,965, making them the largest contributors among state organizations in the country. Thanks, Ohio! Those contributions can be broken down as follows:
ANTITRUST LEGISLATION INTRODUCED IN HOUSE (Wilk Amendment Included) As you may recall, the ACA participated in a lobbying effort last year to enact the so-called "Campbell Bill." The bill, sponsored by the American Medical Association, would have amended the antitrust laws to give physicians, including chiropractors, a wider ability to collectively bargain with managed care plans and other insurance companies. The ACA had put forward a "Wilk Amendment," which was intended to provide that nothing in the new law would limit the application of the antitrust laws to the type of boycott activity experienced during the Wilk days and again being fought in our Trigon litigation. The Wilk Amendment proved to be very popular with other provider groups, and was added to the Campbell bill in a revised form, with the reluctant approval of the AMA. While the bill passed the House of Representatives, it could not get the Senate to take up the measure. Including the Patient's Bill of Rights legislation, no bill put more fear into the hearts of managed care companies than this provision. During this session of Congress, a new proposal has come forward titled "The Health Care Antitrust Improvement Act of 2002 (HR 3897)." HR 3897 is authored by Representatives Barr, Conyers, Norwood, Hoeffel, Ganske, Nadler and Weldon. This bill takes a different approach toward achieving the same end. It would provide for a "rule of reason test" under the antitrust laws in connection with negotiations between groups of physicians, including doctors of chiropractic, and health care plans. Under current law, such negotiations, if discussing fees for example, would be subject to the stricter "per se standard." The new standard would permit parties to demonstrate that the discussions have a pro-competitive effect and, therefore, should not be viewed as violating the antitrust laws. The current standard does not permit such explanations. In addition to this change in the applicable legal standard, the legislative proposal would provide for two types of demonstration projects. The first demonstration project, we are pleased to note, contains the provisions of the Wilk Amendment. The second demonstration project, while it does not have specific reference to the Wilk Amendment, does call for close review of provider/health care plan negotiations by the Attorney General. We have some other concerns regarding this measure and plan to take a closer look at the legislative proposal. But it is clear that ACA's voice and concerns, as expressed in our efforts last year, are being heard and reflected in this year's legislative proposal. But the passage of this measure would bring us a step closer to loosening the stranglehold managed care has on this profession. CHIROPRACTIC PRESENCE IN AMERICAN PUBLIC HEALTH ASSOCIATION For those of you who are relatively new to the profession, it may not mean very much to you that there is a chiropractic section in the American Public Health Association. But the fact is that the APHA, which represents the public health community in the United States, for years refused to even accept the membership of our doctors in its organization. This changed in the early 1990s when chiropractic membership began to be accepted, and in 1995 when a special chiropractic section was established within APHA. Recently, new officers were elected to the chiropractic section, with Dr. Lisa Killinger being selected to serve as chairperson. For information on joining APHA or running for office, email either Cheryl Hawk, DC, PhD at hawkc@palmer.edu or Rand Baird, DC at DrRandBaird@aol.com. TEXAS COLLEGE OF CHIROPRACTIC ADVERTISES IN U.S. NEWS AND WORLD REPORT In the September, October and November issues of U.S. News and World Report, the Texas College of Chiropractic placed a one-page advertisement for its institution in the Texas, Oklahoma, Florida, Louisiana, Arkansas and Georgia issues of the magazine. One of the issues was on the popular subject of America's Best Colleges, and another on the Best Jobs in America. Good-looking ads and smart placements for a reasonable cost…congrats, Dr. Shelby. PRESIDENT BUSH ISSUES BONE AND JOINT DECADE PROCLAMATION: ACA ON STEERING COMMITTEE OF U.S. ACTION NETWORK President Bush has issued a proclamation designating the years 2002-2011 as the National Bone and Joint Decade. The proclamation was issued at the urging of the National Action Network of the U.S. Bone and Joint Decade (USBJD), a group with which ACA has been involved for the past three years. As a member of the Steering Committee of the USBJD, ACA has been working with a multi-disciplinary group of health care organizations to raise awareness of the importance of musculoskeletal health and improve the quality of life for people with bone and joint disorders. Former ACA chairman Dr. Edward Maurer represents ACA on the Steering Committee. In addition to the ACA, organizations represented on the Steering Committee include the American Academy of Orthopedic Surgeons, American Academy of Physical Medicine and Rehabilitation, American College of Rheumatology, American College of Rheumatology Research and Education Foundation, American Osteopathic Association, American Physical Therapy Association, American Society for Bone and Mineral Research, Arthritis Foundation, National Athletic Trainers' Association, National Osteoporosis Foundation, Orthopedic Research and Education Foundation, Pediatric Orthopedic Society of North America, Shriners Hospitals for Children, United Cerebral Palsy Research Foundation. Worldwide, 38 national governments have endorsed the Decade, and more than 750 organizations, health ministries, medical groups and journals have signed a declaration of support. The global Web site for the Decade is: www.boneandjointdecade.org, and the U.S. site is www.boneandjointdecade.org/us. Having the opportunity to include groups within the profession to the mailing list of the Steering Committee to receive its newsletter, we included the following organizations: chiropractic colleges, Foundation for Chiropractic Education and Research, National Board of Chiropractic Examiners, NCMIC, Federation of Chiropractic Licensing Boards, Congress of Chiropractic State Association, Ohio State Chiropractic Association, World Federation of Chiropractic, Council on Chiropractic Education. APPOINTMENTS TO VETERANS ADMINISTRATION ADVISORY COMMITTEE You have seen in Dynamic Chiropractic and through the World Chiropractic Alliance stories about the controversy regarding the recommended slate of candidates for the Veterans Administration Chiropractic Advisory Committee involving the ACA, ACC, WCA and ICA. I am not going to get into the issue of who broke what agreement. Let me just leave you with these facts: The American Chiropractic Association and the Association of Chiropractic Colleges submitted to the Secretary of the Veterans Administration the following slate of candidates for appointment to the Oversight Committee: Drs. Ron Evans, Peter Ferguson, George Goodman, Rick McMichael, Reed Phillips and Carl Cleveland. All except Dr. Cleveland are members of the DOD Advisory Committee, which is working with the DOD in the implementation of the chiropractic provision in the military. They have served in this capacity for years, learning the insides of the military health care system and helping transfer the demonstration project into a permanent benefit for this profession. Including the same representatives on the Veterans Advisory Committee makes tremendous sense, since there is a substantial overlap of issues between VA and DOD. In fact, many VA officials served in an advisory capacity on the DOD committee. Some of the other major chiropractic organizations see the wisdom of these recommendations and submitted letters to the Secretary supporting our slate. These organizations included: the Federation of Chiropractic Licensing Boards, the American Academy of Chiropractic Orthopedics, the Foundation for Chiropractic Education and Research and the National Board of Chiropractic Examiners. Unfortunately, the WCA and ICA have their own slate of candidates. The VA Chiropractic Advisory Committee will play an important role in the expeditious and complete implementation of the chiropractic benefit in the VA system. If experience counts for something, the doctors recommended by the ACA and ACC will be appointed to the committee. Unfortunately, we have seen in the past how the Veterans Administration has used our own inability to be unified to thwart the profession's rightful role in the VA program. Let's hope it doesn't happen this time. CAN'T ACCESS THESE LINKS? Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance viewing anything referred to in this report, please email me at gcuneo@amerchiro.org. 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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