The Great Deception

Now that the Mercy Center Guidelines are beginning to make an impact, the usual deceptions are being perpetrated on the profession. Those with obvious agendas are doing everything they can to deceive you before you get a copy of the guidelines. With time running out before their publication, the half-truths and misrepresentations abound. One such attempted deception occurred recently in the July 1992 issue of The Chiropractic Journal.

Sadly enough, we must now take this editorial space, that was to be devoted to another article about some issues critical to the welfare of the profession, to clear up these deceptions.

Below are just a few of the deceptions that have been designed and calculated to mislead you; they are followed by the truth:

DECEPTION: "Recently, the World Chiropractic Alliance (WCA) raised some eyebrows by being the only national organization to openly support the Mercy Center Standards of Care document."

TRUTH: 1) The Federation of Chiropractic Licensing Boards and the American Chiropractic Association both passed resolutions endorsing both the Mercy Center consensus process and the subsequent guidelines (please see the May 8, 1992 and June 5, 1992 issues). 2) The Mercy Center Guidelines are practice parameters, not standards of practice. 3) When did the WCA pass a resolution supporting the Mercy Center Guidelines? What does that support really mean? Is one individual so powerful within the WCA as to decide for the entire organization? (That is the advantage of not allowing the members to vote on any issues or officers.)

DECEPTION: "... the ACA has so far been strangely silent about it." (The Mercy Center Guidelines.)

TRUTH: At the very first meeting in which the ACA could do so, and before the Mercy Guidelines were even published, the ACA passed a resolution endorsing the Guidelines after thorough analysis of a draft copy of the document by a special committee. In addition, the ACA had most of the Mercy Center Steering Committee available at the ACA convention for additional input. In contrast, who with the WCA reviewed the document? Where are their analysis and recommendations? Was this review performed before or after the WCA decided to join the Straight Chiropractic Accreditation Standards Association (SCASA) and the Federation of Chiropractic Licensing Boards (FSCO) in creating a separate set of guidelines for SCASA oriented chiropractors?

DECEPTION: "The document was developed by a group of doctors and researchers mostly from the ACA and CCE."

TRUTH: All of the participants of the Mercy Center Conference were chiropractors. The members included five chiropractic college presidents (including the president of SCASA), two from ACA colleges, two from ICA colleges and one from a SCASA college. The ICA was well represented at the conference, particularly by their President, R. James Gregg, D.C. Why did no one from the ICA, ACA, a CCE college, the Federation of Chiropractic Licensing Boards or the Consortium for Chiropractic Research participate in the Wyndham Conference? Were they not invited or was there a serious lack of credibility?

DECEPTION: "For instance, the Mercy Center Conference labeled many procedures commonly used in chiropractic offices as less than 'established' (see sidebar). To insurance companies, this means they are investigational or experimental and therefore don't require payment."

TRUTH: This is perhaps the most serious attempted deception of all. The rating system for all procedures consists of six possible ratings. Three positive ratings: "established"; "promising"; and "equivocal"; and three negative ratings: "investigational"; "doubtful"; and "inappropriate." The three ratings are dependent upon the amount and quality of research and/or clinical evidence there is for a certain procedure. As everyone knows, there is very little high quality research for any procedure, chiropractic or medical.

The preface to the Mercy Center Guidelines clearly states: "The first three ratings (established, promising, and equivocal) are all positive. Procedures with any of these ratings are approved for use and reimbursement in clinical practice." Almost all of the procedures listed in the sidebar of the WCA's article have positive ratings, even in light of very little actual research conducted. Why was this deception so important as to be presented in this way? What was the motive behind this deception?

DECEPTION: "I question some of these procedures myself, but it seems as though the Mercy Center participants may have been a bit overzealous in their quest to limit chiropractic to only those 'proven' methods accepted by the medical, pharmaceutical and insurance industries."

TRUTH: The Mercy Center Guidelines provide documented support to all chiropractic practices that can be reasonably demonstrated through clinical evidence or actual research. The initial responses in many circumstances throughout a number of states is that the Mercy Center Guidelines have been used to defend the rights of chiropractors to utilize procedures that could have been lost without a document of this magnitude (please see "How will the Mercy Guidelines Affect the Chiropractic Profession" in the July 3, 1992 issue.

DECEPTION: "It is easy to see that insurance companies and courts will interpret this as a two week cap on chiropractic services. If your patients aren't better in two weeks, say goodbye and send them to a medical doctor."

TRUTH: The Mercy Guidelines provide for a "four week total" period of treatment before the patient must show "documented improvement". This means that if you treat a patient for four weeks and see absolutely no improvement, that you must look at other therapies. This is a much greater period than many third party payer programs currently allow. What good are guidelines that tell you it is OK to treat a patient forever without any sign of improvement?

DECEPTION: "Can you really afford the Mercy limitations?"

TRUTH: The Mercy Guidelines clearly secure procedures and treatment rights that have been whittled away by insurance companies and the courts over the past years. They will put an end to unethical claims review and establish solid ground for a DC to treat a patient and know that they will be paid. It is opening doors into HMO, PPO, ERISA and other health insurance plans across the country (please see "California Workers' Comp. Pilot Project Involves Chiropractic" and "Blue Cross/Blue Shield of New Jersey to Conduct In-House Chiropractic Workshop" in the July 17, 1992 issue).

In summary, there is no way to stop those who are constantly practicing their fine art of deception with the chiropractic profession. In this case, all you need to do is wait four to six weeks before the Mercy Center Guidelines document is available from Aspen Publishers. If you are a chiropractor in the United States, you will receive it free of charge in the mail.

Ignore misrepresentations and half-truths. Read it for yourself and develop your own conclusions. Then, instead of being deceived, you will be informed.

DMP Jr., BS, HCD(hc)