Memorandum
To: ACA Members, House of Delegates, Board of
Governors and Other Interested Parties
From: Garrett Cuneo
Re: ACA EVP Weekly Report
Date: July 14, 2003
The following items are covered in this week's report:
1. NACA REAFFIRMS ITS SUPPORT FOR ACA's TRIGON LAWSUIT WITH A FORMAL RESOLUTION
2. ACA'S MEDICARE EFFORTS HIGHLIGHTED IN WASHINGTON POST
3. MEDICARE UPDATE
4. SENATE MEDICARE CONFEREES SELECTED
5. LANDMARK TAKES POSITIVE STEP
6. CHIROPRACTIC MANAGED CARE INDEX: ISSUE #2
7. MALPRACTICE BILL STRUCK DOWN IN SENATE
8. INSURANCE AND CODING SEMINAR HELD IN CONJUNCTION WITH THE ACA ANNUAL MEETING
9. CAN'T ACCESS THESE LINKS?
1. NACA REAFFIRMS ITS SUPPORT FOR ACA's TRIGON LAWSUIT WITH A FORMAL RESOLUTION
The National Association of Chiropractic Attorneys (NACA), composed of chiropractic state association attorneys from throughout the country, met recently in Monterrey, California, and passed a resolution reaffirming its support for our lawsuit against Trigon BlueCross BlueShield, and in particular our decision to appeal the adverse decision by Judge Jones.
The resolution stated in part:
"Now therefore be it resolved, that the National Association of Chiropractic Attorneys reaffirm its support of the American Chiropractic Association and the Virginia Chiropractic Association in their prosecution of the suit and appeal and urges the chiropractic community nationwide to continue or add its support to the American Chiropractic Association and the Virginia Chiropractic
Association in their endeavor to successfully prosecute the pending appeal."
I had reported to you previously the supportive comments from Mike Schroeder of California and Bob Hirtle of Connecticut, considered to be two of the more knowledgeable attorneys on antitrust law involved with the profession. The resolution from NACA adds significance to their comments and is consistent with the level of support we are receiving from throughout the profession.
A copy of the entire resolution posted here: http://www.acatoday.com
and lives here:
http://www.acatoday.com/legal/trigon/naca_reaffirms.shtml
with a link also from the main trigon page:
http://www.acatoday.com/legal/trigon
2. ACA'S MEDICARE EFFORTS HIGHLIGHTED IN WASHINGTON POST
ACA's lobbying efforts on the contentious Medicare bill have achieved national attention. Dan Morgan of the Washington Post, in a front-page story about the Medicare bill, discussed ACA's efforts to gain inclusion in the bill through our proposed chiropractic demonstration project on Monday, July 14. The article clearly demonstrates that our efforts -- and our members' grassroots action -- are making waves. Here is a link to the full article:
http://www.washingtonpost.com/wp-dyn/
articles/A51512-2003Jul13.html?nav=hptop_tb
Please read on to find out the latest on the Medicare situation.
3. MEDICARE UPDATE
Last week the U.S. Senate appointed its representatives to the Senate/House conference committee (see below) which decides the differences between the House-passed and Senate-passed versions of the Medicare modernization bill. As of today, the House had still not made its appointments, but we have a pretty good idea of who they will be. As you may recall, the Senate version contained our demonstration project and the House version did not. If you have been following the stories in the newspapers, the work of the conference committee will undoubtedly be difficult, working through the summer. The White House wants a bill, and no matter how complicated this comprehensive bill is, in all likelihood the White House will get it. Our job is to be sure that whichever bill reaches the President includes our provision.
Our focus the next couple of weeks will be on getting members of the House Ways and Means Committee members committed to our provision and willing to send a letter to Congresswoman Nancy Johnson (R-CT) urging her to support it during the conference committee. There is no doubt that she will be an important conferee. Our lobbyists have talked to all members of Ways and Means, and the members have either committed to doing this or at least to giving it some thought. Congressmen Jim Ramstad (R-MN) and Earl Pomeroy (D-ND), who serve on the committee, are circulating a letter to their colleagues urging this same action. Grassroots efforts are important now. Members of the committee who have already committed include Representatives Leonard Boswell (D-IA), Virgil Goode (R-VA), Steve Israel (D-NY), William Janklow (R-SD), Rick Larsen (D-WA), Ed Schrock (R-VA), Jim Ramstad (R-MN) and Earl Pomeroy (D-ND). Those who are considering our request and need grassroots pressure include: Representatives Phil Crane (R-IL); Jim Nussle (R-IA); Clay Shaw (R-FL): Amory Houghton (R-NY); Wally Herger (R-CA); Jim McCrery (R-LA); Dave Camp (R-MI); Sam Johnson (R-TX); Jennifer Dunn (R-W) Michael Collins (R-G); Rob Portman (R-OH); Phil English (R-PA); J.D. Hayworth (R-AZ); Jerry Weller (R-IL); Kenny Hulshof (R-MO); Scott McInnis (R-CO); Ron Lewis (R-KY); Mark Foley (R-FL); Kevin Brady (R-TX); Paul Ryan (R-WI) and Eric Cantor (R-VA).
For further details, contact ACA's Government Relations staff or visit www.acatoday.com
4. SENATE MEDICARE CONFEREES SELECTED
Senate Republican leaders have just announced members for the upcoming conference committee, tasked with reconciling the House and Senate versions of Medicare reform legislation. The committee will include the following: Senate Majority Leader Bill Frist (R-TN), Minority Leader Tom Daschle (D-SD), Finance Committee Chair Charles Grassley (R-IA), Finance Committee ranking member Max Baucus (D-MT), Judiciary Committee Chair Orrin Hatch (R-UT), Budget Committee Chair Don Nickles (R-OK) and Senators Jon Kyl (R-AZ), Jay Rockefeller (D-WV) and John Breaux (D-LA).
5. LANDMARK TAKES POSITIVE STEP
At ACA's urging, Landmark Healthcare came to the table on May 22, 2003, with concrete recommendations to change their x-ray guidelines and administrative processes that will make it easier for network providers to get paid. Over the past 18 months, data has been collected on chiropractic managed care networks, and that data has made it possible to talk about specific details with network leaders to obtain necessary change. Beyond the clinical radiology criteria which has been made more flexible, Landmark has responded favorably to changes in pre-certification and the appeals process so doctors can have a more hassle-free system.
Soon, Landmark will be announcing movement toward a gold card program, which will be geared to eliminate pre-certification requirements for a cross section of network doctors. Landmark is also evaluating prior appeals to determine how doctors can avoid the appeal mechanism to get paid. Also on the books is a commitment from Landmark leaders to meet with state-level doctors to problem-solve at the local level. A meeting facilitated by ACA and hosted by the New Jersey
Forum is planned for September. Please contact Pat Jackson, ACA's Vice President, Professional Development and Research
pjackson@amerchiro.org, if a local meeting would benefit the doctors in your state. Landmark is the first chiropractic network to make meaningful changes at the request of ACA membership. We view this as a responsible sign and hope it will carry over to other networks where similar concerns exist.
6. CHIROPRACTIC MANAGED CARE INDEX: ISSUE #2
The ACA is pleased to announce the second in a new series of education articles designed to inform doctors of chiropractic (DCs) on insurance and managed care issues. The Chiropractic Managed Care Index focuses on issues faced by new graduates, including network evaluation and provider agreement review, but includes information for experienced DCs as well.
The CMCI, developed under the direction of the ACA's Insurance and Managed Care Committee, is distributed six times per year, and is available only to ACA members via the ACA website. The second issue, Look Before You Sign: Evaluating the Provider Agreement, is available at:
http://www.acatoday.com/insurance/mc_index
The ACA appreciates your comments on CMCI. Please forward these to David Page - Manager, Insurance and Managed Care at:
dpage@amerchiro.org
7. MALPRACTICE BILL STRUCK DOWN IN SENATE
On July 9th, the Senate voted to block a Republican-backed bill that would cap non-economic damages in malpractice lawsuits at $250,000. The 49-48 vote falls 11 short of the 60 votes required to break a Democratic filibuster and bring the measure up for a formal vote. Although the House passed similar legislation earlier this year, the Senate vote is an outright defeat for the AMA on their top legislative priority. Following the vote, the AMA's President, Donald Palmisano, recognized that the group knew where senators really stood on the issue and was quoted as saying, "This puts names down." Senate Majority Leader Bill Frist, MD (R-TN), said that the bill would be brought up again as early as this fall. The vote could become a key issue in the 2004 elections, particularly in states that have been hit hard with rising malpractice insurance rates, including Florida, Nevada and West Virginia.
8. INSURANCE AND CODING SEMINAR HELD IN CONJUNCTION WITH THE ACA ANNUAL MEETING
The annual meeting of the ACA House of Delegates is scheduled for September 17-21 at the Hyatt Regency Hotel in Albuquerque, New Mexico. In addition to the usual business of the House of Delegates, ACA is offering a one-day seminar on navigating the coding process and tracking insurance companies reimbursement decision-making. The first part of this one-day seminar will be hosted by Dr. Mark Sanna, President of Breakthrough Coaching, who will provide you with
an understanding of codes and their appropriate applications. Part two of this presentation will be hosted by Ms. Pat Jackson, Vice President of the ACA Professional Development & Research Office, who will prepare you to negotiate with insurance companies to effectively bring about policy change and eliminate claim by claim fights for fair chiropractic practice and pay. CEU's are pending in New Mexico.
Cost for this one-day 6 CEU program:
ACA Members: $95.00
Non-ACA Members: $115.00
NM Association Members: $95.00
Save! Each additional DC from the same office - just $65.00!!
If your practice involves insurance reimbursement, you can't afford to miss this session. To register, contact ACA at 800-986-4636.
9. 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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