Why the Profession Should Have a Chiropractic Lobbyist in Every State

Senate Bill 533 recently passed the Oregon legislature and allows for established chiropractic patients to continue treatment with their current chiropractor, ensuring continuity of care. This new Oregon legislation will allow established chiropractic patients who are subsequently injured on the job and are enrolled into a closed-panel managed care organization (MCO), of which their current DC is not a member, to continue treatment with their chiropractic physician. This legislation represents the most recent of several political wins for chiropractic in Oregon's worker's compensation system, and the eighth significant bill we have gotten passed since 2005.

With the passage of Senate Bill 1197 in 1990, chiropractic physicians in Oregon were severely restricted in worker's compensation. Senate Bill 1197 reduced chiropractic physicians' attending physician status from full attending physician status for the life of the claim to 12 visits or 30 days, whichever came first. After 12 visits or 30 days, injured workers would have to switch to a medical or osteopathic physician as their attending physician.

In 2006, the Oregon Workers' Compensation Division performed a retrospective study of claims data to determine the cost of chiropractic management versus medical management of injured workers. This study was ordered by then-Governor Ted Kulongoski due to the huge bipartisan support for an Oregon Chiropractic Association (OCA)-proposed randomized, prospective cost-comparison study contained within the OCA's House Bill 2588, introduced during the 2005 legislative session. That bill passed both the House and Senate, but Governor Kulongoski vetoed the bill. The 2006 retrospective study by Oregon's Workers' Compensation Division validated what we already knew: Chiropractic care results in reduced costs and time loss compared to standard medical care.

The positive findings of this retrospective study helped fuel House Bill 2756, which passed during the 2007 legislative session and expanded chiropractic physicians' attending physician status to 18 visits or 60 days. In 2009, we passed House Bill 2045, allowing chiropractic physicians the ability to rate permanent impairment for injured workers.

In this same year, we gained new administrative rules that created new forms to reinforce the legal fact that Oregon's injured workers can treat with the health care provider of their choice, not the least of which is a doctor of chiropractic. We also successfully pushed through a new administrative rule that allowed for an "omitted condition" space on our Form 827, a first report of injury and change of physician forms to counter the usual limited and/or inaccurate medical diagnoses injured workers were receiving at the local hospital emergency room or urgent care clinic.

We will be introducing legislation to continue to address the inappropriate and illegal "steering" of injured workers by employers and insurance claims representatives attempting to require injured workers treat with a certain provider or local occupational medical clinic – in direct violation of Oregon law. Oregon's closed-provider-panel MCOs are extremely restrictive to doctors of chiropractic, allowing few on panels, which is inappropriate and results in higher medical costs, increased time loss and poorer outcomes for injured workers.

We are introducing legislation that will open these panels or at the very least, require a minimum percentage of DCs in each "geographic service area" (GSA) to be allowed on the MCO panels. We are also introducing legislation that will require our state to utilize the most current version of the American Medical Association's guides to rating permanent impairment. Currently, Oregon utilizes a great deal of the antiquated (23-year-old) 3rd revised edition of the AMA Guides, published in 1990 and no longer in print.

Colleagues, the importance of having "one of your own" as the chiropractic lobbyist in your state is paramount. A chiropractic lobbyist will provide not only an educated understanding of your issues, but also an intense passion for those issues that money just can't buy. I share this important fact with you because law-makers confide in me time and time again that my credibility as a chiropractor representing only the chiropractic profession rises above that of a lay lobbyist, who comes to them with limited knowledge of our unique issues, no passion for those same issues, and usually representing a multitude of clients. Hire a chiropractic colleague as your paid lobbyist; there is no substitute.