Task Force's Health Professional Review Group Includes Chiropractic

On April 1, 1993, Jerilynn Kaibel, DC, a practitioner from San Bernardino, California, was notified by officials of Hillary Clinton's Health Care Task Force that she had been selected to the Health Professional Review Group (HPRG), a multidisciplinary health panel that will act, in Dr. Kaibel's words, as a "provider audit" group.

The HPRG will have the opportunity to review the White House proposal for health care reform prior to its presentation to Congress.

Dr. Kaibel met with the HPRG April 12-13 at the Old Executive Office Building in Washington, D.C. The panel, when fully staffed, will comprise 46 health care representatives, a smorgasbord of providers, a tribute to the democratic principle that all contingents shall be heard. Chiropractic's voice will be heard, its input imparted, albeit a solitary voice in a cacophony of attention seekers.

Dr. Kaibel's road to Washington began when officials of the HPRG contacted the American Chiropractic Association seeking a chiropractic representative. Dr. Kaibel was one of a number of likely candidates for the job. In February 1992, she was appointed to a one-year term on the Practicing Physicians Advisory Council (PPAC) of the Department of Health and Human Services by then HHS Secretary Dr. Louis Sullivan, a 15-member group that advised Congress, HHS, and the Health Care Finance Administration on Medicare policy matters.

Her work in Washington and her position as the ACA's delegate for Southern California, coupled with the down-to-earth clinical experience of being a two-office practitioner, provided a nice marriage of political savvy and clinical expertise, two commodities that made her an excellent choice to represent chiropractic on the Health Professional Review Group.

Her curriculum vitae is impressive: president of the California Chiropractic Association (1986-87); CCA "Doctor of the Year" (1986-87); two terms as director of the Congress of Chiropractic State Associations; appointed by Calif. Governors Brown and Deukmejian to the Medical Quality Review Committee, and served six years as its chairperson; appointed by Calif. Insurance Commissioner John Garamendi to the Fraud and Abuse subcommittee of the Workers' Compensation Task Force; appointed by the Calif. Board of Chiropractic Examiners as Commissioner on Examination in physical therapy; Independent Medical Examiner (Calif. Dept. of Industrial Relations); and Qualified Medical Examiner (Calif. Industrial Med. Council).

Dr. Kaibel related that the April 12-13 meetings allowed the group to meet with policy makers in the health reform process, and senior Congressional and HHS officials. Ira Magaziner, President Clinton's senior policy advisor for policy development, spoke at length, assuring the importance of HPRG's participation in the overall process.

Hillary Rodham Clinton, appointed by the president to head the task force for health reform, met and spoke with each member of the HPRG.

The HPRG members were asked to submit their ideas for health care reform. The following are Dr. Kaibel recommendations:

• Guarantees of patient freedom of choice of health care providers. Antidiscrimination language is needed to protect patients' right to choose non-MD health providers for covered services. Insurance equality laws have been adopted in a majority of states, including 41 that specifically apply to the services of DCs. These laws protect the rights of millions of consumers who have their health care needs met by alternative, nonmedical providers. Such language will help the administration meet its commitment to preserve patient choice of doctors.

   

• Expand access to primary care. Consumers should be encouraged to seek primary care services from licensed non-MD health care providers to the extent they are permitted under state law. Under the existing medical model, these providers are often "locked out" of health care delivery systems despite having broad diagnostic and treatment authority granted under state license. Eliminating barriers to consumer choice of licensed health care providers is one way to expand access to primary care.

   

• Encourage the delivery of preventative health care services. Doctors of chiropractic help meet this need through their traditional emphasis on overall patient wellness. With broad state granted diagnostic authority and training, DCs identify health problems before they become serious and costly. DCs use "common domain" diagnostic techniques including physical exams, lab services, and x-rays. Federal policies should not curtail a patient's ability to receive these services from doctors of chiropractic.

   

• Increase access in rural and medically underserved areas through student loan repayment, geographical payment adjustment and community-based health care services. Existing programs such as the National Health Services Corps and other health manpower program should be made eligible to DCs and other licensed health care providers.

   

• Retain the commitment to medical outcomes assessment research through the Agency for Health Care Policy and Research (AHCPR) and other federal agencies. Chiropractic educational and research institutions should be included in these efforts.

   

• Encourage the development of professional standards of care for health disciplines. The American Chiropractic Association and the Federation of State Chiropractic Licensing Boards have endorsed a set of consensus standards of care -- known as the Mercy Center Guidelines -- based on the latest outcomes assessment and clinical research. Other disciplines should be encouraged to follow suit.

   

• Reform the medical liability system. "Defensive medicine" drives health costs higher by encouraging marginal or unnecessary services by providers seeking to avoid frivolous litigation. The current system should be reformed in keeping with the recommendations of the National Medical Liability Reform Coalition, of which the American Chiropractic Association is a member.

As of press time, the White House had chosen not to identify the 46 panel members, but Dr. Kaibel was told the announcement was imminent. Dr. Kaibel did indicate that the nursing profession was heavily represented in the HPRG, which indicated to her that the nursing profession may play a large role in national health care reform. Clearly chiropractic is not the only profession hoping to gain a greater primary care status.

Dr. Kaibel commented that the first lady's task force is wrapped in a "dome of silence," seconding the observations and frustrations of the media and health care providers concerning the task force's direction, leaving only rumors and speculations about the shape of the health care reform package.

The HPRG will be meeting again April 22-26 in Washington; we'll be following the group's progress.

Chiropractic is fortunate to have someone of Dr. Kaibel's experience and abilities representing the profession. We know Dr. Kaibel will be an eloquent, intelligent, and cogent voice for chiropractic -- now if only the powers that be are open enough to fairly include this sometimes misunderstood and maligned profession in its national health care scheme.

Stephen Kelly
Assistant Editor