Network Data Collection Project Managed Care Data Collection Form
(for PDF version - click here)As a longtime insurance official, I have first-hand knowledge of how strained the relationship has been between doctors of chiropractic and the insurance industry. For over 30 years, I have witnessed such horrible offenses as not allowing doctors of chiropractic into state peer-review organization buildings to meet with medical staff, and claim adjusters who rampantly refused to recognize doctors of chiropractic as physicians.
It was not until I joined the ACA that I witnessed similar treatment of DCs by those within the chiropractic profession. It's no wonder a growing segment of this profession perceives that some chiropractic networks are placing profits over the viability of the chiropractic profession.
Lack of unity and constant bickering over nonstrategic issues continue to drain energy that could be focused on the core professional goals of seeing that doctors of chiropractic are paid fairly. Success in this one area would exponentially help individual doctors of chiropractic and the profession at large.
Someone has to do something about our current situation with managed care in chiropractic. Briefly, here are the ACA's initiatives on managed care:
- In January 2002, the ACA hosted a managed care summit meeting in Washington, D.C., bringing together representatives of many chiropractic networks to discuss the serious provider concerns in dealing with managed care. From that meeting, the network representatives developed ideas designed to improve the relationship between DCs and chiropractic networks. As a result of this, the ACA developed a managed care matrix of professional responsibilities, which was later approved by our Board of Governors. (Please see sidebar that identifies the goals defined in the matrix of professional responsibilities.)
- In February 2002, in response to statements made at the managed care summit, the ACA House of Delegates passed a resolution regarding managed care that included the following:
"The American Chiropractic Association has long been concerned over the harmful and discriminatory practices of managed care organizations, particularly chiropractic networks and third-party administrators affecting proper patient care and the practice of chiropractic. We vehemently oppose these harmful and discriminatory practices, including, but not limited to: limiting full scope of practice, inappropriate CPT applications and reimbursement policies, use of discount/affinity programs, restrictive limits of care, and improper utilization review."
The resolution continues: "...that ACA staff and leadership are directed to communicate our concerns to the profession; obtain detailed data on these abuses; develop and implement a plan to halt these unfair practices; and give a status report in August 2002 and at each subsequent House of Delegates meeting."
- In March 2002, ACA asked for input into the managed care matrix document and for conceptual support from networks. Three-quarters of the networks that attended the summit agree with the general concept of the matrix and are willing to establish a business relationship to advance these goals.
- In June 2002, the National Committee on Quality Assurance (NCQA) and the American Accreditation Healthcare Commission (URAC) evaluated the matrix goals and determined them to be consistent and not in conflict with their standards of managed care accreditation. Their determination eliminated concerns that some of the chiropractic managed care networks had voiced.
As called for by the managed care resolution, data collection on MCOs is being implemented. ACA will work with the Federal Trade Commission (FTC) to ensure that our collection of this data and its provision to MCOs and others falls within one of their antitrust safety zones.
| Matrix of Professional
Responsibilities - Promote a market value proposition that considers client demands, their expectations of network providers, and the needs of the chiropractic profession.
- Create a "new mindset" about the chiropractic network's role in advocating for the patient and practitioner.
- Develop education and other resources for the chiropractic profession that positively impact chiropractic practice variations, clinical performance and clinical documentation.
- Promote network utilization management policies and procedures that allow the treating practitioner to determine patient medical necessity, make care-related decisions and provide input on required patient treatment guidelines.
- Encourage clients to engage in an assessment of provider reimbursement structures to support full scope of services.
- Convert affinity discount products to insurance paid plans.
- Simplify network administrative practices and the reporting burden on plan providers.
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It's important for managed care networks to fully understand their member concerns. ACA will attempt to work with the MCOs on initiatives to place chiropractic cost offsets and other data in front of major insurers and employers to advocate for expanded chiropractic benefits.
The ACA needs your support in our effort to collect and analyze the data. Please take a few minutes to completely fill out the Managed Care Data Collection form, and fax it to us as soon as possible.
We owe it to ourselves and to our patients to assemble the data required to generate viable solutions. The financial and human resources being expended by the ACA and the networks toward greater chiropractic coverage are worth this effort.
Thank you for your participation.
Patricia Jackson,
ACA vice president, professional development and research
