Memorandum
To: ACA Members, House of Delegates, Board of Governors, and Other Interested Parties
From: Gary Cuneo
Re: ACA EVP Weekly Report
Date: January 21, 2003
The following issues are covered in this week's report:
1. DUKE SHORT JOINS THE ACA LEGISLATIVE TEAM
2. STATEMENT ON CCE GENERATES INTERESTING COMMENTS
3. SHOWTIME TO AIR ANTI-CHIROPRACTIC PROGRAM FEATURING PENN & TELLER
4. ACA LEGISLATIVE PRIORITIES: GOOD REASON TO ATTEND NCLC
5. CAC MEMBERS AND BLUE CCHIP REPRESENTATIVES TO HOLD MEETINGS AT NCLC
6. WHAT IS YOUR IMPRESSION OF THE ACA: MEMBER SURVEY
7. EMMITT SMITH PRAISES CHIROPRACTIC AGAIN
8. NEW MEDICARE FEE SCHEDULE PUBLISHED
9. ACA AIDS IN RESOLVING CLAIMS PAYMENT ISSUES FOR UNITED HEALTHCARE PROVIDERS IN OHIO AND FLORIDA
10. LOCAL CHIROPRACTIC LEADERS & ACA SUCCESSFUL IN CHANGING BC/BS POLICY
11. ACA PRESENTS EKORNES
12. CAN'T ACCESS THESE LINKS?
1. DUKE SHORT JOINS THE ACA LEGISLATIVE TEAM
In the November 18th issue of the Congressional Record, Senator Trent Lott said the following about Duke Short, the long time chief of staff to Senator Thurmond: "I know many Senators have gone to Duke and sought out his counsel as one of our longest serving and most effective staff members...In many ways Duke has been the Senate's un-elected 101st Senator..." Meanwhile, Senator Orrin Hatch stated in the same issue of the Congressional Record, "I rise today to pay tribute to the man we in the Senate fondly knows as 'Duke Short.' Duke is to be commended for his fine work and years of dedication to our country..." And Senator Jeff Sessions said, "Over the years he [Duke] has earned a reputation as someone who always conducted himself with utmost integrity and honesty. Given greater authority -- perhaps more than almost any other staff member in the Senate -- he always dedicated himself to the highest principle of public service..."
Duke Short has joined our legislative team to assist us in implementing our legislative program. His experience with the Senate Armed Services and Senate Veterans Affairs Committees will be particularly helpful. Duke has worked in the Senate since 1974, but did you know that he is also a doctor of chiropractic, receiving his chiropractic degree from Palmer College of Chiropractic? Dr. Short certainly knows our problems and will be a great addition to our team.
2. STATEMENT ON CCE GENERATES INTERESTING COMMENTS
My January 6th EVP report included a statement of support for the work that the Council on Chiropractic Education (CCE) does. I received seven or eight fairly detailed responses criticizing ACA for this position, some even accusing the ACA of being anti-Life University.
The ACA supports CCE's decision relative to the loss of Life's accreditation since, from what we understand, Life was not following CCE standards. However, my report also included a paragraph that was obviously missed or ignored by many. It stated that the ACA had requested that the CCE review its 2-year requirement before a school can apply for accreditation status. The ACA letter, which was signed by the ACA Chairman and the ACA President and sent to CCE President Dr. Reed Phillips, requested that the 2-year CCE standard in question be changed.
ACA sent the letter because we believe that the Life University Board of Trustees has taken important steps to correct the problems that caused the institution's loss of accreditation status. The current CCE Standards would preclude Life from applying at this time even if it had corrected all of its problems.
It is my understanding that this issue was discussed extensively by the CCE Board of Directors last week and assigned to a task force for study. It is also my understanding that the ACA was the only national or state organization that raised this issue with the CCE Board of Directors.
Based on the ACA's proactive letter in support of fairness for Life University, it is simply ridiculous for anyone to attempt to now paint the ACA as being anti-Life University. Those who criticize our position should ask a legitimate question of other organizations. Where were they? Where are the letters to CCE from other associations raising this important issue? As far as I know, other than Life University, the ACA was the only organization to request a review of the two-year rule. A copy of the ACA's letter to Dr Phillips follows. We intend to continue to monitor the situation to ensure that Life University is treated fairly in its efforts to regain accreditation.
December 3, 2002
Reed Philips, DC, PhD, President
Council on Chiropractic Education
8049 North 85th Way
Scottsdale, AZ 85258-4321
Dear Dr. Phillips:
As representatives of the ACA who have been long-time supporters of high educational standards and the work of the Council on Chiropractic Education, we are writing to suggest an amendment to the CCE Standards. We direct your attention to Section III, A. 1. that reads as follows:
e. In place for the most recent two-year period, the following items as described in detail in the CCE Standards.
(1) Formal action taken by its governing board at a legally constituted meeting that commits the DCP to follow the Standards, Policies and procedures for accreditation, as set forth in various official CCE documents.
(2) DCP mission, goals, and objectives that embrace those stated in the Standards, Section 2.
(3) A DCP that complies with the Standards.
The ACA is concerned that Item e.(3) could be strictly interpreted to mean a chiropractic program must be in full compliance with all CCE standards for two years prior to applying for accreditation. In our opinion, that interpretation would be illogical since the accreditation process (self-study, site visits, etc.) only begins after formal application is made. If applied in this manner to Life University, we believe their re-accreditation effort would be unfairly harmed.
To better clarify the intent of this provision, we believe it would be beneficial for the CCE Board of Directors to amend line e. to read as follows: "In place at the time of application, the following items as described in detail in the CCE Standards." If the "two-year period" needs to be retained in the Standards, and alternative solution would be to replace the term "complies with" in item (3) with the word "embraces" or the word "endorses."
We hope this information is helpful and look forward to hearing from your on this issue.
Sincerely,
Daryl D. Wills, DC
ACA President
James D. Edwards, DC
ACA Chairman
3. SHOWTIME TO AIR ANTI-CHIROPRACTIC PROGRAM FEATURING PENN & TELLER
Beginning January 24, 2003, cable network Showtime will air a controversial new series called "Penn & Teller: Bullsh**!" The series, featuring comedians/magicians Penn & Teller, aims to discredit or expose TV psychics, alien abductions and other contentious subjects. The second installment of the program, set to air at 11:00 pm ET/PT on Friday, January 31, will address alternative medicine; with chiropractic care included the program's crosshairs. Other targets of the episode on alternative medicine will include reflexology, magnet therapy and an alternative medicine fair. While it is not exactly clear what the attack against chiropractic will entail, we do know that chiropractic care for infants will be discussed - and the program will not be good publicity for the profession. Employees of both Showtime and Learly Productions (the company that produced the series) have been less than forthcoming about the program, as they are very aware of the controversial nature of their program. The first episode (Friday, January 24) will focus on TV psychics.
ACA's legal counsel is sending a letter to Showtime in protest of this action. After reviewing the program, we will advise the chiropractic profession on further action.
4. ACA LEGISLATIVE PRIORITIES: GOOD REASON TO ATTEND NCLC
The ACA Board of Governors, following the recommendations of the ACA Legislative Commission, has recommended the following legislative priorities for 2003:
· Medicare
· ERISA (Patient Bill of Rights)
· Implementation of Student Loan Program
· Veterans Affairs
· Department of Defense
· Anti-Trust
· Federal Employee Health Benefits Program
· Supplemental Security Income (SSI)/Disability
The theme for this year's National Chiropractic Legislative Conference (NCLC) is "Direct Access: Insure the Future." Come to NCLC and help us push our legislative priorities and obtain the legislation that will help our patients receive chiropractic care!
NCLC, scheduled for March 5-8, will be held at the Hyatt Regency Washington conveniently located on Capitol Hill. To make your room reservation, please call the Hyatt Regency Washington at 202-737-1234. When making your room reservation, please mention that you are with the American Chiropractic Association to get the special group room rate of $219.00 per evening for a single or $244.00 for a double room. The Hyatt Regency is located at 400 New Jersey Ave., NW, Washington, DC 20001. Please note the room reservation cutoff date is February 7, 2003. After that date, the hotel will not guarantee room availability or the special group rate.
5. CAC MEMBERS AND BLUE CCHiP REPRESENTATIVES TO HOLD MEETINGS AT NCLC
NCLC is more than just the promotion of chiropractic legislation. This year's program includes a special meeting for Medicare CAC representatives as well as one for Blue CCHiP representatives. This is the second year in the row that ACA representatives of Blue CCHiP companies throughout the country gather together to compare notes on their successes and disappointments. Ms. Patricia S. Jackson, our in-house insurance expert with over 20 years of insurance experience, has put together a terrific program. It includes such topics as "Insurance
Relations That Work: A Case Study of Two Blue CCHiP Programs;" an update on Utilization Review/Clinical Guidelines; ACA legal counsel presentation on avoiding the problems of Anti- Trust issues when talking to insurance companies; and a discussion of ways to be more effective when dealing with local Blue Cross/Blue Shield Plans. Look in next week's report for information on the CAC program.
6. WHAT IS YOUR IMPRESSION OF THE ACA: MEMBER SURVEY
Living in Washington, D.C., it's easy to believe that the only smart people in the world reside here. The old "father knows best" mentality is alive and well. Fortunately, not everyone feels that way, and your leadership is attempting to reach out to the membership to gauge your impression of the job we are doing. Past Vice President Spiro Agnew coined the phrase "the silent majority." In our case, it's the checkbook doctor who pays his or her dues and isn't part of the vocal minority. When they are upset, they generally stop paying their dues. We want to hear from the doctors in the field. Are we doing as good a job as we think we are? Please answer the simple question you'll find below. I will be providing this information to the Board of Governors.
Question: What is the one word that best describes your impression of the ACA?
Please copy and paste this question along with your response to me.
7. EMMITT SMITH PRAISES CHIROPRACTIC AGAIN
Emmitt Smith, the star running back for the once-feared Dallas Cowboys, has once again professed his support for this profession. In the February issue of Playboy magazine, Emmitt was asked what recommendation he would make to NFL owners. His response was, "Provide massage and chiropractic services. Those things are necessary to keep players healthy, and healthy players stretch the owners dollars." While some might think it would have been better if this quote had appeared in another magazine, the statement is nevertheless a great one.
8. NEW MEDICARE FEE SCHEDULE PUBLISHED
On December 31, 2002, the Centers for Medicare and Medicaid Services (CMS) published the Medicare Physician Fee Schedule. The 2003 Medicare conversion factor will be reduced 4.4% effective March 1, 2003. This follows a reduction of 5.4% in 2002. The conversion factor has been reduced from $36,192 in 2002 to $34,592 in 2003. The information below indicates a comparison of the national relative value units (RVU) and Medicare reimbursement rates: Be mindful that the figures noted are not specific for any geographic region. These are the national average figures for chiropractic manipulation.
· 2002 RVU
98940- .71
98941- .98
98942- 1.27
98943- .75
· 2002 Fee Schedule
98940- $25.70
98941- $35.48
98942- $45.97
98943- $27.14
· 2003 RVU
98940- .70
98941- .97
98942- 1.27
98943- .65
· 2003 Fee Schedule
98940- $24.21
98941- $33.55
98942- $43.92
98943- $22.48
Please be advised that this decrease in the conversion factor affects all healthcare professions under Medicare-not just chiropractic.
For more information see: Federal Register-Volume 67-December 31, 2002
9. ACA AIDS IN RESOLVING CLAIMS PAYMENT ISSUES FOR UNITED HEALTHCARE
PROVIDERS IN OHIO AND FLORIDA
ACA worked closely with United HealthCare (UHC) officials on reported claims payment concerns that affected UHC practitioners in Ohio and Florida. Thanks to input from ACA members and the state associations, ACA and UHC identified the claims payment errors. UHC officials communicated with ACA leadership throughout their investigation. A notice on the resolution has been distributed to the two state associations and to doctors of chiropractic in Florida and Ohio.
10. LOCAL CHIROPRACTIC LEADERS & ACA SUCCESSFUL IN CHANGING BC/BS POLICY
In May of 2002, Dr. Anthony Mirando, Chairman of the Washington, D.C., Board of
Examiners; Dr. Thomas Connelly, President of the District of Columbia Chiropractic Association; and Dr. Bruce Nordstrom, ACA Delegate to Washington, D.C., met with representatives of CareFirst Blue Cross/Blue Shield of D.C., Maryland and Delaware to discuss several concerns. Following that meeting, Dr. Nordstrom requested ACA's assistance concerning CareFirst's automatic denial of E/M codes for doctors of chiropractic. On June 13, 2002, Dr. Anthony
Hamm, Chairman of the ACA Coding and Reimbursement Committee sent a letter directly to Daniel Winn, MD, Medical Director at CareFirst Blue Cross/Blue Shield. His letter stated, "The CareFirst position on Evaluation and Management codes is incorrect and is not consistent with current nationally accepted standards."
Recently, the ACA received a response from CareFirst Blue Cross/Blue Shield on their new E/M code policy. The new policy is now in line with accepted national standards and went into effect late October 2002. The new policy allows the E/M on the same day as CMT for:
· The evaluation of a new patient
· The evaluation of an established patient with a new condition (modifier -25)
· The reevaluation of a new or established patient, with the same condition, every 30 days, to determine if a change in treatment plan is necessary
· The evaluation of a patient when his/her condition requires a significant, separately identifiable E/M service above and beyond the usual pre/post service work associated with CMT (modifier -25)
In addition, we recommend that all doctors include medical documentation when billing E/M codes to support medical necessity. This will help to prevent a delay in payment.
This is a great win for all doctors of chiropractic, as it shows the positive benefits of insurance outreach with plan medical directors. And it allows existing coding policy to be more easily integrated into claim reimbursement practices.
11. ACA PRESENTS EKORNES
ACA is pleased to announce an addition to its portfolio of product endorsements - the "Stressless" seating solution from Ekornes. This premium line of reclining sofas and chairs provides comfort and quality through its unique adaptive features, including a unique "plus" system that ensures correct support for both the head and lower back. The chair also features adjustable headrests and a freestanding ottoman. And to truly fit each individual, chairs are available in as many as three sizes. To find out more about the "Stressless" seating solution, find your local retail outlet at
www.ekornes.com.
ACA and Ekornes are now jointly preparing marketing activities geared for the chiropractic professional and will be issuing a general news bulletin in the near future. Please look for additional details in upcoming issues of the EVP Report and ACA Today. For additional information about the endorsement, contact Caroline Fuchs at
cfuchs@amerchiro.org.
12. 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 e-mail me at
gcuneo@amerchiro.org.
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