Chiro. Assoc. of Oregon and IPA Join Forces
Four years ago, as the wave of health care reform began to roll, an innovative group of chiropractors decided they needed to get ahead of it before it took the profession under. Managed care was becoming the buzz word in the profession, but the members of the Chiropractic Association of Oregon (CAO), didn't see these provider networks benefitting them or chiropractic in the long run. "It was evident to me and the other founding members that something needed to be done," said Dr. Bryce Milam, president and founding member of the IPA (Individual Practice Association). "Too many times chiropractic managed care organizations were willing to compromise and sell the providers short in order to get the contract. The profession needed an organization that would negotiate in their best interest, and insurance companies needed a network that would provide care that was cost effective and valuable to their insureds. That's simply the basis on which the IPA was founded: quality chiropractic care, cost containment, and improvement of the profession."
The CAO/IPA utilizes the Chiropractic Association of Oregon's code of ethics and membership application process to establish a pre-certification of potential members for their panel. The CAO also provides full service membership services expected of a state chiropractic association. Julie Young, long-time executive director of the CAO explained: "CAO members agree to abide by a code of ethics and policies on public health. Over the past years, the CAO (formerly the OCPA) has lobbied for and passed laws that improve the profession, i.e., peer review under the board of examiners which allows the profession to review itself and set guidelines and standards of practice. The IPA is an extension of the CAO's efforts, a truly separate association to answer issues specific to managed health care and its role in the chiropractic profession."
The CAO/IPA does not have a suppressive membership policy which will damage our profession like many organizations. Doctors are not restricted based on numbers per zip code or minimum years in practice. The CAO/IPA does have firm written policies and procedures. Care is based on standards of practice that the members agree to abide by. The CAO/IPA provides pre-certified care or, at the insurer's request, evaluates the care to be provided or that has been provided. The Individual Practice Association was developed as an unlimited panel, restricted only by a thorough credentialing process.
The organization itself is run as a not-for-profit organization, so it does not attempt to take a cut off the top to fill the pockets of its owners. This leaves more revenue for the participating providers. Dr. Larry Lubcke, quality assurance director for the IPA, has been part of the organization virtually since it began. He recently stated, "This group's main goal is to provide quality care, cost containment, and to educate and improve the profession." Other networks try to limit their panels to control costs. The CAO/IPA's approach is dramatically different. The IPA promotes large panels limited only by the doctor's willingness to abide by ethical standards of practice. The IPA also has the review mechanisms to ensure provider compliance. This gives the insurers and the doctors what they need to work together in this era of managed care.
The CAO/IPA will only sign contracts which give full attending physician rights. This means contracts signed by the IPA board provide for direct access with no medical physician referral required. Not only that, but chiropractors are paid under the same fee schedule as MDs in all contracts. The IPA is committed to this idea, so that chiropractors are not treated as specialists, but become "mainstream." IPA chiropractors are treating physicians under three contracts: two are workers' compensation contracts with Health Future Enterprises, based in Medford, and Comp Inc., based in Portland. The CAO/IPA has one general health contract with Qual Med of Oregon which provides for direct access to chiropractic services at a fair benefit amount. "There are two items that the CAO/IPA will always require when negotiating a contract, direct access to our providers and fair reimbursement. In return our members are expected to provide the best chiropractic care available," explained Dr. Milam.
What has at times been an adversarial relationship between physicians and insurance companies, is now becoming a partnership with the development of a claims' review system like no other. Dr. Larry Lubcke and Dr. Vladimir Shulga have developed a training program, and report writing system that provides insurance companies with a panel of experts. IPA reviewing doctors review PIP cases for State Farm, Farmers, Allstate, and Nationwide in Oregon, using a system based on the Oregon Chiropractic Practice and Utilization Guidelines. Each recommendation is supported with text while educating chiropractors on charting, billing and treatment. Dr. Vladimir Shulga, co-developer of this system stated, "There has not been a greater time for establishing an open working relationship between the profession and third-party payers. It is imperative for the chiropractic profession to seize this opportunity and resolve any differences we have had in the past. The IPA's review process allows us to accomplish this."
The IPA panel provides insurance companies with much needed advice and direction on chiropractic care. The goal is to have as many trained reviewers as possible, which results in true peer review. This process will also serve to educate the majority of chiropractors in Oregon and provide cost containment in the long run. Dr. Lubcke asserted that chiropractic can't effectively take its rightful place in health care unless we are a trusted part of the team. "Fairness to the treating DC, the insured, and the insurance company are the goals," he said.
