We Get Letters & E-Mail

Spanish DCs Also Worried about "Quickie" Courses for Non-DCs

Dear Editor,

I would like to chime in with Dr. Kemski in Germany about her concerns about American chiropractors teaching quickie courses to unqualified, unprepared people in Europe. We have had our share of this in Spain. There is no law here regulating who can call themselves chiropractors, and because the word of chiropractic's effectiveness has spread, we have our share of imitators. We have at least three schools here in Valencia, Spain teaching adjusting courses, one of those a spinology school which I understand to have ties with the now defunct spinology program in the U.S.

We can complain all we want, but until chiropractic laws are passed in each country, this practice will continue as long as a profit can be made. Perhaps it is time for the national and state organizations to pass some policies with teeth. Perhaps it is possible to censure chiropractors engaged in such activity by banning their teaching in all countries where chiropractic is recognized, and revoking their licenses to practice in these same countries.

Dan Schlenger, DC
Valencia, Spain

Dear Editor,

Having just received July's Dynamic Chiropractic, I was of course disheartened to hear of members of my profession's involvement in our most recent embarrassment, "FBI Snares California Fraud Ring," as if our image could stand even more damage. To those outside the profession, we can only say, "We're working on it," and if we're not, the FBI certainly is. Fraud is fraud and it should not be tolerated.

That having been said, while your cover story highlighted this heightened sensitivity and reduced tolerance to medical fraud, because of my recent personal experience, I am in a quandary.

When my 16-year-old son and basketball star recently suffered a split eyebrow while playing city league basketball, it was one of those cuts that made you wonder whether it required stitches. The cut was about an inch long (ultimately requiring four stitches), but I asked myself, "Would it scar worse if not stitched?" Its angle and placement made it difficult or impossible to apply a butterfly bandage without leaving his lid raised (it was almost bedtime).

His cut had occurred in the evening, and so regular office services were unavailable. We headed for our local and newly built hospital ER.

After signing papers acknowledging my financial responsibility, we waited our turn. After 30 or 40 minutes, we were ushered into our assigned curtained treatment cubicle. Within two to three minutes, my son's history was taken and his blood pressure was obtained. I believe that I must have blinked when the examination was done.

On first impression, the resident clinician stated "Boy, I don't know, a bandage might almost work." Then spreading the tissue, after all was said and done it was decided that there might be less scarring with stitches.

Within 10 minutes face-to-face, a local anesthetic was applied and four stitches were placed. And I might say, the doctor was very pretty.

Then about three weeks later, I received in the mail (inside one of those darkened envelopes) my bill itemized with a copy attached. I could have heard a pin drop. Is this why they use the darkened envelopes? Let's see, four stitches, 10 minutes, for $525.

Are there special licenses which allow hospitals to mark up supplies to exorbitant (extreme) levels? A box of latex gloves (100 per box, hypo-allergenic premium) at Price-Co, costs approximately $3. I believe one pair was used during my son's care. That works out to about $.06 cost for the gloves, charged at $6.05 or about an 11,666 percent mark up. Is the FBI interested in this?

This brings me back to your article, and the subject of fraud, or is it? Is it possible that these are "honest charges" (meaning we should all adjust our fee schedule), or is this "misrepresentation" and "price gouging."

Could there be a connection between the American Hospital Association and the Defense Department? Are there hidden relationships here of which I am unaware? Are they who manufacture $10,000 toilet seats for our military aircraft, the same who manufacture suture kits for hospitals, or are these aberrations working independently? Or are these aberrations at all? Am I unfair to assume that these were overcharges?

If these charges are "unfair," are they "dishonest" and if so, should this fraud be reported and prosecuted, or is this 1995 medical-economic reality?

To the side, are hospitals required to post their charges in public places, and if not, why not? Would not a requirement for written estimates keep them honest? I truly believe that by requiring such public disclosure would be so embarrassing to these institutions that such disclosure would force a "reality check" and would greatly finally encourage actual competition within the "medical market."

To put it another way, had an estimate been available and had one been presented to me and my son, that (my) charges would likely reach 500 big ones, I can assure you that I would have offered my son "$300 and keep the scar," and I would have saved $200. I diverge.

I believe that the general public would simply be delighted with a "fair service at a fair price." The attached itemization reaches the ridiculous.

Had we been informed that the curtained cubicle (which was not drawn, I might say) would be charged at $84.55 for 10 minutes, I might certainly have said, "Hey, let's do it in the lobby." The 30-second exam at $87.70 ("Yeah, it's a cut) is laughable. The laceration tray at $150.55 (was it stainless steel or titanium) and reusable yet? I think I feel a fever coming on. I feel like George Banks' wieners and buns in "Father of the Bride."

Explanations for these exorbitant charges ring hollow. Friends and colleagues are at first outraged by my story, but then say:

"That's what medical institutions do. That's just how it is, (and so it's okay)." Would that be coincidence, or would it be collusion?

"Hospitals charge that much because they have greater expenses. They are not very efficient." I say that would be a matter of scale, and we all have expenses.

"Hospitals charge that much because of all their bad accounts. They make the rest of us pay." Are they suggesting the rest of us in practice don't have "bad" accounts?

"Hey, you're paying for their medical expertise." I say we are not talking kidney-transplant here. We are pondering one of the simplest, age-old medical procedures.

Is one fraud, deception or trickery acceptable but not another?

Donald Wilson, DC
Davis, California

Dear Editor,

Shouldn't this Medicare issue have been handled properly by now? After all, how many years will Medicare recipients choosing chiropractic need to go through the hassles presented to them by our bureaucracy of freedom?

A recent case comes to mind and, unfortunately showed me another example of the Catch-22 mentality at HHS. I understood all the lip service that we could now refer Medicare patients to hospitals/radiologists for x-rays again with certain codicils that provided a host of unending questions. But I never knew that Medicare would not pay for services of a patient when referred directly to a specialist for treatment of a condition, not diagnosis.

A 66-year-old female with a history of breast CA enters the office complaining of neck pain radiating into her right wrist. The usual clinical evaluations are done, including bone scanning to r/o the possibility of metastatic CA. The bone scan finds a fracture of the right wrist, acute in nature and verified by x-ray taken after the bone scan. The patient still cannot recall any trauma. I take the appropriate steps and make the referral to an orthopedic surgeon for follow up treatment. Rational so far? I thought so.

The patient brought to me an EOB from Medicare which stated that they were not going to cover the treatment services of the orthopedist since the patient was referred for treatment by a chiropractor. Of course, they didn't use the word "chiropractor," they used those magic words "a provider of this type."

Take a look around doctors. Notice if you will that more and more HMO/PPO plans are beginning to smell just like Medicare: you know, the 12 visit magic number, x-ray limitations, and referral limitations. Doesn't it give you the impression that many carriers are using Medicare "guidelines" as a model for future policy? It certainly does.

But what of our leadership in Arlington, Virginia? They are consistent: fighting for chiropractic inclusion in HMO/PPO plans. Fighting for that magic 12 visit number! What we really need to see our leaders do is fight for our rights as licensed physicians to do the work we have been trained to do and make judgments based on clinical relevancy regardless of who pays, Medicare, group, HMO/PPO or non-insured patient. Instead, we see the opposite. Fighting for acceptance and inclusion. Doctors, acceptance isn't granted to us by anyone outside of our own body. We build reputations based on our individual works within our offices and our "acceptance" is between our own ears. Do we really think things will continue to change between allopathic professionals and ourselves?

It is time for us as individual practitioners to create the practice environment we seek by enlisting the army we have among our acres of diamonds: the patients we treat. They are what we can use to change the picture. After all, we have seen enough of our leadership doing the same old things and expecting different results: the perfect definition of insanity!

Gary Rubenstein, DC
Vineland, New Jersey

Dear Editor,

Thank you for mentioning my web page under the listing, "Chiropractic Neurology Diplomate Sites" in Dr. Darryl Curl's July 1, 1996 column.

However, there was a period left out in my site location. The correct address is [url=http://206.124.65.1/cpow/chiro.htm]http://206.124.65.1/cpow/chiro.htm[/url].

Thank you,

Julie Powell
Carrollton, Texas

Dear Editor:

I have one of the "first" chiropractic web sites, created in 1994, called "Chiro~Web" (not to be confused with the commercial ChiroWeb, which decided to "borrow" this name that I first made up). My web site is: [url=http://pages.prodigy.com/CT/doc.doc.html]http://pages.prodigy.com/CT/doc.doc.html[/url]

The page is a comprehensive guide to chiropractic resources through the Internet.

Andrew Bayuk, DC
Milford, Connecticut
DEAB74A@prodigy.com

Dear Editor:

I want to first thank you for your fine job in keeping our profession informed with your publication. It has been said time and time again in several chiropractic publications that a lack of unity in our profession is one primary hurdle holding our profession back. We as a profession have made substantial advances, but I can't help but think we would be leap years ahead of where we are now if we could speak as one voice. I rationalized early on in practice that because there were four separate state associations in my state and two national associations, that I wasn't going to support any of them until we had one association in the state and one nationally to speak for our profession. After freeloading a few years, I was convicted and convinced I was hindering the advancement of my profession more by sitting on the side lines than by joining and supporting our most active, visible and organized state and national organizations. I've spoken with several colleagues who have yet to be convicted or convinced that their involvement and support of our "divided house," whether on a state or national level, is unnecessary.

I am writing this letter to encourage us all to set aside those things which continue to keep our profession divided, and move toward unity on all fronts for the advancement of the profession. It's way overdue. Those sitting on the sidelines may also become convinced their support is needed in a new unified profession. The whole is greater than the some of its parts. If you don't think your contribution to the whole of this profession is necessary, read and think about this.

Am I really needed?

Xvxn though my typxwritxr is an old modxl, it works wxll xxcxpt for onx of thx kxys. I'vx wishxd many timxs that it workxd pxrfxctly. Trux, thxrx arx 42 kxys that function, but onx kxy not working makxs thx diffxrxncx.

Somxtimxs, it sxxms to mx that our organization is somxwhat likx my typxwritxr -- not all thx pxoplx arx working propxrly. You might say "Wxll, I'm only onx pxrson. It won't makx much diffxrxncx. " But you sxx, an organization, to bx xffecixnt, nxxds thx activx participation of xvxry pxrson. Thx nxxt timx you think your xfforts arxn't nxxdxd, rxmxmbxr my typxwritxr, and say to yoursxlf, "I am a kxy pxrson and thxy nxxd mx vxry much."

If you're not a member of your state or national association, call them and let them know that you support them and would become a member of a unified profession. We can't let the next 100 years happen, we need to help make them happen. In the mean time, consider joining the most active, visible and organized state and national organizations. Become a part of the solution. Gary E. Harcourt, DC York, Pennsylvania

P.S. Did I forget to mention unity is way overdue.