We can breathe a huge sigh of relief now that the American Chiropractic Association (ACA) has succeeded in getting the U.S. Department of Health and Human Services to rule that physical therapists cannot deliver the chiropractic benefit under Medicare. More importantly, Secretary Tommy Thompson's Operational Policy Letter (www.amerchiro.org/images/jan15_2002_letter.jpg) can be used in state legislatures across the country to help ensure that untrained persons are not allowed to practice chiropractic by correcting subluxations.
The issue of manipulation by PTs has long interested me. While reviewing the subject in 1995, I discovered a flaw in the Kansas Medical Practice Act that resulted in Kansas Attorney General Opinion 96-12, stating that Kansas MDs were not statutorily authorized to perform this service, they, of course, cannot delegate or prescribe the procedure for PTs to perform.
Since that time, I have been contacted by chiropractic representatives from over 30 states requesting assistance in crafting statutory language that would protect the public from untrained persons performing manipulation. As a result, several states have introduced "manipulation" bills; a few, like Tennessee, have successfully enacted good bills into law.
The major problem in crafting legislative language of this type concerns the "manipulation-versus-adjustment" argument. If you preclude others from performing adjustments, PTs will just call them something else and continue thrusting into joints. If you just preclude others from performing manipulation, some in the profession feel you have not really protected the chiropractic adjustment.
Until recently, I didn't think there was a solution to this problem - until I reviewed New Jersey Senate Bill 2693. After reading it, I was truly amazed that the answer was so simple: Preclude others from performing both manipulation and adjustments.
In my opinion, the New Jersey bill is the Magna Carta of manipulation/adjustment, and is nothing short of a masterpiece. It allows only MDs, DOs and DCs to perform "manipulation" and allows only DCs to perform "adjustments." Therefore, no matter what you call it, if a person thrusts into a joint, he or she had better be a DC, DO or MD. And if that person represents the thrust as an "adjustment," he or she had better be a DC.
The language in SB 2693 is sheer brilliance. I commend its creators for finally drafting a bill that covers all the bases, and most importantly, protects the public. I also wish them the best in their efforts to get it passed. To assist chiropractic associations at the state level, I have reworded the New Jersey language into the following "model bill" that can easily be modified for individual state use.
The American Chiropractic Association has ensured that physical therapists cannot perform manual manipulation to correct a subluxation under Medicare. It is time to fight this battle at the state level. Should you have any questions, or if I can assist in any way, please contact me at the email address at the bottom of this article.
| Model Bill AN ACT to protect the public from unauthorized, unqualified, incompetent and improper application of spinal adjustments and manipulations of the spine and supplementing (statute references).
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(Note: Alternatively, section 3 could allow the state medical, osteopathic or chiropractic board to initiate action against those who violate the act. It could also outline the legal penalties for non-health-care providers who violate section 2.)
James D. Edwards,DC
Chairman of the Board
American Chiropractic Association
Arlington,Virginia
jamesedwards@jamesedwards.com
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