Orange County Chiropractic District

ACA Weekly Report - 04/28/03

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Memorandum

To: ACA Members, House of Delegates, Board of Governors, and Other Interested Parties
From: Gary Cuneo
Re: ACA EVP Weekly Report
Date: April 28, 2003

The following items are covered in this week's report:

1. JUDGE RULES IN THE TRIGON CASE
2. BLUE CCHIP SCORES IN APRIL
3. ACA APPOINTMENTS TO RUC/HCPAC AND NCQA COMMITTEES
4. USBJD, JACA EDITORIAL ADVISORY COMMITTEE APPOINTMENTS
5. A SNEAK PEEK AT YOUR MAY 2003 ISSUE OF JACA
6. ACA ON THE ROAD
7. WebMD CONTACTS ACA AS STUDY IS PUBLISHED BY BRITISH MEDICAL JOURNAL
8. CAN'T ACCESS THESE LINKS?

1. JUDGE RULES IN THE TRIGON CASE

After deliberating for over five months, Judge Jones ruled in favor of the summary judgment motion filed by Trigon Blue Cross Blue Shield. In an 18-page opinion, he supported the arguments of Trigon that the chiropractic doctor/patient plaintiffs hadn't shown that Trigon's anti- chiropractic actions were the result of a conspiracy with the medical societies in Virginia. He, in effect, ruled that the medical societies, by appointing representatives to advise Trigon on such matters as the low back guidelines, made them advisors to Trigon and, hence, part of Trigon's decision-making apparatus- -and not outside conspirators. We are naturally disappointed.

However, our preliminary analysis of the opinion indicates that it is flawed. Our attorneys are doing a more detailed review, and once it is completed we will issue a more detailed statement regarding this matter.

We have 30 days to decide whether to appeal, and I would be extremely surprised if our board of governors didn't take this action. While we would have preferred to have prevailed, an Appeal does give us a chance to not only challenge the judge's opinion in this instance, but also his rulings in the past that kept us from subpoenaing Trigon on their records prior to 1996, including their thinking on why they chose to misinterpret the AHCPR guidelines on low back pain.

2. BLUE CCHIP SCORES IN APRIL

The month of April has been a dynamic time for two states involved in ACA's Blue CCHIP initiative. While the state of Montana has seen tough times in their dealings with Blue Cross Blue Shield, they had a marked success earlier this month with the appointment of Dr. John Sando, ACA Alternate Delegate, to the Medical Policy Making Committee. Dr. Sando marks the 15th th liaison with an appointment to an internal BC/BS committee or placement in an advisory role. This appointment follows a meeting held earlier in the year of both ACA and Montana Chiropractic Association (MCA) officials with BCBS of Montana. In addition, North Dakota Blue CCHIP has seen a victory with a marked increase in E/M code reimbursement of nearly 50%. While there is still a lot of work to be done in these states, and across the country, it is achievements like these that let us know the Blue CCHIP Program is working to open the lines of communication.

3. ACA APPOINTMENTS TO RUC/HCPAC AND NCQA COMMITTEES

ACA volunteers are an important part of what makes this association effective. Recently, ACA President Dr. Daryl Wills , with confirmation from the ACA Board of Governors, designated representatives to key outside agencies.

Based upon ACA's recommendation, the AMA named Dr. Anthony Hamm, ACA's Coding and Reimbursement Chairman, to the Relative-value Update Committee/Healthcare Professionals Advisory Committee (RUC/HCPAC), the official committee in which specialty societies have input into the value of CPT codes. This is a rigorous process that assesses specialty research and survey data and other information that supports the CPT code values made to the Centers for Medicare and Medicaid Services (CMS) each fall. Dr. Hamm begins his appointment in April 2003. Dr. Hamm replaces Dr. Joe Johnson, who will continue to serve as the Secretary's appointment to the HHS Physician Payment Advisory Committee (PPAC).

Additionally, Dr. John Gentile, Chairman of ACA's Insurance and Managed Care Committee and ACA's delegate to Florida, was named as the ACA representative to National Committee for Quality Assurance (NCQA). His appointment begins in July 2003. NCQA is the national accrediting agency for managed care companies and establishes the standards for quality of care and compliance.

4. USBJD, JACA EDITORIAL ADVISORY COMMITTEE APPOINTMENTS

Dr. Ken Spresser of Arvada, CO, has been appointed by the ACA Chairman Dr Jim Edwards as ACA's representative to the Board of the United States Bone and Joint Decade (USBJD). The Bone and Joint Decade is a global, multi-disciplinary initiative to build awareness of the prevention and treatment of musculoskeletal conditions. As a member of the United States BJD Board, ACA has input into the activities of this prestigious organization. Participating organizations include the American Academy of Orthopedic Surgeons (AAOS), the American Osteopathic Association, the Arthritis Foundation and other health provider and disease prevention groups. You can visit the USBJD Web site at http://www.boneandjointdecade.org/us/.

Dr. Alan Adams has been appointed by ACA President Dr Daryl Wills as chairman of the JACA Editorial Board.. The JACA Editorial Board reviews all articles before they are published in JACA for accuracy and appropriateness. The members meet once a year at NCLC to discuss the upcoming editorial calendar and to make suggestions for other articles. Because the board also tackles larger publications questions and responsibilities, it was elevated from a committee to a board under the leadership of Dr. Maurer in 2002.

Both positions were previously held by our good friend, Dr. Ed Maurer, who passed away last month

5. A SNEAK PEEK AT YOUR MAY 2003 ISSUE OF JACA

As a new monthly feature of this report, I plan to give you a small taste of what you can expect to find in the upcoming issue of the Journal of the American Chiropractic Association (JACA). Here are a few highlights from the forthcoming May, 2003 issue:

bulletChiropractic Diagnostic Instrumentation: This article examines the diagnostic instruments the typical doctor of chiropractic needs, and how complex and computerized they need to be-as well as answering some important questions about reimbursability.
bulletInternal Carotid Artery Dissection Following Chiropractic Manipulation: Clinical Features and Mechanisms of Injury: While the medical literature contends that cervical chiropractic manipulative therapy (CMT) may cause internal carotid artery dissection (ICAD), the authors of this article conclude that the relationship between ICAD and CMT remains tenuous, and a causal relationship is not supported by the literature.
bullet2003 JACA Survey: You can help determine the future direction your journal takes. Please let us know what you think.

6. ACA ON THE ROAD

Just about every weekend ACA representatives are on the road promoting the lawsuits. This past weekend was no exception.

ACA governors Dr. Lew Bazakos and Dr. Glenn Manceaux traveled to the University of Bridgeport College of Chiropractic to participate in the first "SACA Day" at the campus. They were given the opportunity to discuss ACA membership and provide an update on ACA's legal action. SACA students raised $1,300 in cash and a few hundred per month in pledges for the National Chiropractic Legal Action Fund (NCLAF). It was a good day for the ACA.

Last Friday, I was luncheon speaker for the ACA Council on Nutrition, which was holding its meeting in Washington D.C. Speaking before 120 doctors, I was given the opportunity to show the Dr. Carl Cleveland-narrated film, "Simple Justice," and to provide an update on our legal action. The council presented me with a check for $2,500, bringing its total contribution to $12,500. The Council on Nutrition has been by far is the largest contributor to the lawsuits among the specialty councils. I was also pleased to receive several monthly pledges toward NCLAF. ACA legal counsel Tom Daly, ACA associate director of production Nataliya Schetchikova, and I, were each given special recognition awards from the council.

7. WebMD CONTACTS ACA AS STUDY IS PUBLISHED BY BRITISH MEDICAL JOURNAL

A reporter from WebMD immediately contacted the ACA as the British Medical Journal prepared to publish a study on April 25 showing that manual therapy is more cost effective than traditional therapy for neck pain. While the study did not focus on the core of chiropractic (spinal adjustment / manipulation), it did indicate that manual, low-velocity, passive movements, which can be provided by chiropractors, osteopaths and physiotherapists, are more effective and less costly for treating neck pain than care by a general practitioner. ACA governor and Executive Committee member Dr. George McClelland participated in an interview with the WebMD reporter who contacted the ACA. Dr. McClelland's interview with WebMD demonstrates yet again that ACA is the place where the media turn when looking for reliable health care information.

8. 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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