The recent Mercy Center Conference that established the Guidelines for Chiropractic Quality Assurance and Standards of Practice document, has caused much controversy in the profession regarding its necessity and conclusions. Questions have been asked how the guidelines will impact chiropractic practice styles in the United States, and its ultimate usage.
The cost of health care is rising nationally at more than double the rate of the GNP. In 1991, the inflation rate was 3.5 percent with the inflation rate for health care, tobacco, and new cars at 7.6 percent. In some states, over 25 percent of all citizens were without any type of health insurance. Lee Iacocca, president of Chrysler, states that the cost of health care is higher than the cost of steel in every car that Chrysler produces. Government health care is the major topic in the upcoming presidential election campaigns and has already contributed to the defeat of politicians who have not addressed the issue. Increased government control for health care is coming. It is estimated that by 1995, 80 percent of all medical reimbursement will be from some level of government. The public is wanting and needing the government to take charge.
In 1989, the U.S. Congress established a new Federal Agency called the Agency for Health Care Practice and Research (AHCPR). It was charged with establishing the appropriateness, effectiveness, quality, and access of health care and research. This organization was on the same level of government as the FDA. The AHCPR called for every health care profession to establish guidelines and standards of practice for the federal government to use in setting reimbursement schedules and rules under the coming government health care scheme.
With these facts in mind, all segments of the chiropractic profession were invited to gather at the Mercy Center in January 1992, to cooperatively establish a standards of care document under which the entire profession could survive. This was accomplished in a spirit of harmony with no acrimony or lack of cooperation. Everyone that attended realized how important this document would be to the future of the entire profession. What was produced was a statement that was broad enough for 95 percent of all chiropractors in America to practice under. Very few limitations were imposed. The document showed that chiropractic was scientific and effective. It shifted the focus of chiropractic practice from a philosophical standard to a scientifically-based outlook. The Mercy Center document did not ignore the traditional tenets of the profession and gave many caveats and recognition to the basic philosophy of chiropractic. These are included in the final document. It was hoped that the Mercy Center document would enable federal policymakers to set up reimbursement guidelines that would enable all chiropractors to be paid for their professional skill and expertise, fairly and completely, as are the other health care professions.
In the April 1992 issue of the World Chiropractic Alliance (WCA), the Chiropractic Journal, there was a front page article announcing the Wyndham Conference, May 13-17, 1992, in Chandler, Arizona. The conference is to "provide guidelines for an ethical practice based on subluxation correction." While the purpose in conducting this meeting is understandable, there are questions about the eventual usage of the document that may be produced. The stated intent of this conference is to write a "straight" standards of care document. Some of the same doctors that participated in the Mercy Center Conference will be involved in this second effort to draw up standards that have a different slant. This is understandable on the surface, as the recent Mercy Conference document admittedly is broad in scope. However, with two documents purporting to be the "standard" of chiropractic professional practice, it would be unclear to ERISA administrators, government policymakers, malpractice attorneys, and insurance companies which document they are to follow. Which particular philosophy a group holds is of no concern to these decision makers. Generally they feel that this is an internal matter for resolution within the profession.
There are many questions that would be raised by the Wyndham "straight" standards. If there is a decision made by those in administrative positions to follow the purportedly narrow standard of the Wyndham Conference, what will happen to the broader scope practitioners? Will these doctors be denied reimbursement based upon the Wyndham document? Will this be fair to the broad scope practitioner? Would the broad scope document impair the narrow scope doctor's ability to practice in any way?
What will happen is that federal government policymakers, ERISA bureaucrats, insurance policy writers, and workers' compensation reformers will choose to implement what appears to be the less expensive option. Specifically, if one document (Wyndham) says that DCs don't utilize supplements, modalities, rehabilitation, etc., and the other one (Mercy) does, it could be concluded that the narrower scope standards would be cheaper to implement, because all you would have to pay for is a hands-on adjustment only, like Medicare. In discussions with congressmen and other government policymakers, the document that will save the most money and cost the least, is the one that would be used. This will devastate the profession as the majority of chiropractors use more than adjustment in their therapeutic approach.
The stated purpose of the sponsoring organization, the WCA, is to "further the common business interests of all chiropractors regardless of philosophy or education." If another standards of care document is produced, it will only confuse those outside the profession and may result in no inclusion at all in government health plans of the future. The WCA needs to reconsider the sponsorship and promotion of the Wyndham Conference on the basis of potentially causing the restriction of reimbursement of the majority of the chiropractic profession. The WCA repeatedly says that their organization is for the benefit of all chiropractors. If this is so (and I believe them) the WCA, upon reflection, can see the potential for damage that can arise from having two conflicting documents that purport to represent the profession. It is common sense to say that all chiropractors can practice under broad interpretation standards, but all chiropractors, as they currently practice, could not practice under narrow standards.
In conclusion, what is feared is a repeat of the Medicare mess we are currently in, with a very limited payment schedule. The broad scope members of the profession would not like to continue with this level of government reimbursement. Since the purpose of a standards of care document is for the federal government to set down regulations for the future of payment under government health care, it would behoove the profession to make those rules as broad as possible. The government will attempt to limit us as much as possible anyway. If these rules are limiting in nature, the majority of chiropractors will not be paid for what they do. We are primary care doctors and must be compensated for our knowledge and skill. We don't want to have to practice under government health care that turns out to be like the current Medicare system. When Medicare rules were set many years ago, a narrow scope was used, and look what we have now.
I urge all fellow doctors of chiropractic to think about the points just raised. This is important to your continued professional health. If you are a member of the WCA and agree with me that this is possible, let it be known how you feel to the headquarters of the WCA. If you are a conservative (straight) chiropractor, think about what will happen to your professional colleagues. Remember your tenet of "live and let live." The standards of the Mercy Conferences will not hurt your practice. Help us all survive by stopping the Wyndham Conference.
John L. Martin, D.C.
Austin, Texas
Immediate Past President
Congress of Chiropractic State Associations
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