A June 26 report by the U.S. Department of Health and Human Services' Office of the Inspector General (OIG) - Chiropractic Care: Comparison of Medicare Managed Care and Fee-For-Service - reveals, according to the American Chiropractic Association (ACA), a "startlingly unexplainable reduction" in chiropractic services available, especially to patients enrolled in Medicare HMOs that require a physician referral to a chiropractor.
In 1996, more than one million Medicare beneficiaries participated in Medicare managed care organizations with a physician referral requirement. However, according to the OIG report, only 6,200 (0.61 percent) - 61 hundredths of one percent - were referred for chiropractic services. That number increased to 0.96 percent in 1997 and a "whopping" 1.08 percent (10,000 per million) in 1998. However, chiropractic services in Medicare fee-for-service were much higher during the same period - between 4.15 percent and 4.42 percent.
"This report drives home the fact that Medicare managed care patients are systematically being denied access to doctors of chiropractic," said ACA President Dr. James Mertz. "It also underscores the importance and validity of our lawsuit against the federal government. Doctors of chiropractic are obviously being discriminated against in these plans, and Medicare managed care patients are not receiving the chiropractic services they are entitled to by law."
ACA representatives said that the latest OIG report is consistent with its earlier studies and is in keeping with the government's position that allows MDs and DOs to provide manipulations to Medicare beneficiaries in lieu of chiropractic services. This is the core issue in the ACA's litigation against HCFA.
"The government has been forced to agree with ACA's legal position that physical therapists should not be permitted to provide the uniquely chiropractic physician service of manual manipulation of the spine to correct a subluxation," noted Dr. Mertz. "It is well known in the industry that ACA has filed litigation on not only that point, but also on the point of medical doctors and doctors of osteopathy providing chiropractic services. "
While DCs performed 91 percent of the manipulations in 1998 for the 110 managed care plans thatresponded to the OIG's survey, only 110 out of the 310 plans responded to the inquiry. The ACA feels this number is not representative of the plans as a whole. Dr. Mertz was also concerned that the ACA litigation may have affected the OIG survey responses from the managed care plans. Those concerns have prompted the ACA to file a request under the Freedom of Information Act (FOIA) for OIG survey questions and answers.
"Nevertheless," Dr. Mertz added, "even the results of the survey as presented by the OIG show that the percentage of chiropractic services provided in Medicare managed care plans is drastically lower than the percentage provided in Medicare fee-for-service plans."
The federal court for the District of Columbia is now reviewing a motion by the government to dismiss the ACA's lawsuit against HCFA, and the ACA's response to that motion.
