FCA Applies for Exemption from Medicare 12 Visit Rule

On September 22, 1992, the Medicare Committee of the Florida Chiropractic Association (FCA) requested a "formal exemption for waiver of the 12 visit prepayment screening parameters for chiropractic manipulations." The request, filed by Committee Chairman Joe W. Johnson, D.C., ultimately seeks to remove the 12 visit parameter in favor of a more patient oriented approach consistent with current literature and guidelines.

The FCA's application for the exemption required a demonstration that the 12 visit screen was not a standard. This could only be accomplished by documentation and research. Indeed, the FCA's request is thoroughly documented, beginning with the recital of a section of the 1992 Florida Health Care Reform Act that requires the development of practice parameters for all health care professions.

The second exhibit is the Mercy Guidelines, used to demonstrate "that the 12 visit screen is disruptive and a hindrance to chiropractic practice and is not a logical number at which to screen."

"Treatment Frequency and Duration: A Literature Overview and Clinical Impressions for Quality Assurance of Medicare Patients" is the third exhibit, a very comprehensive overview of most of the applicable research on this subject, including 39 references that will prove a strong argument against the 12 visit screen.

A fourth exhibit, "An Overview of Chiropractic Efficacy and Economic Impact Assessment," gives a detailed discussion of the economic advantages of chiropractic care beyond the 12 visit screen. This overview is also well referenced.

The remaining seven exhibits supply additional cogent support to the FCA application:

"1991 Chiropractic Rehabilitation Facility Standards";

"The Appropriateness of Spinal Manipulation for Low-Back Pain" (RAND study);

The Chiropractic Manual, published by the Ohio State Chiropractic Association;

"An Overview of the ACA Cost of Care Analysis Project" by Miron Stano, Ph.D., professor of economics and management at Oakland University;

"Executive Summary 'A Comparison of Health Care Costs of Chiropractic Versus Medical Patients'" by Miron Stano, Ph.D.;

"Executive Summary 'A Cost Comparison of Health Care Costs of Chiropractic Versus Medical Patients in Florida'"; and

"Mandated Health Insurance Coverage for Chiropractic Treatment: an Economic Assessment with Implications for the Commonwealth of Virginia" by Leonard G. Schifrin, Chancellor Professor of Economics, the College of William and Mary.

When asked about the FCA effort, Medicare Committee Chairman Joe Johnson, D.C. said: "We in Florida are relentless in our efforts to get this 12 visit screen and other Medicare 'injustices' changed. If the waiver is denied, we will request screening on a per episode basis. According to RAND a 'per episode' basis is 5-18 visits. Other literature shows a 'per episode' mean of 12-19 visits."

Apparently, Blue Cross/Blue Shield of Florida (BC/BS) is in agreement with the FCA position. According to Dr. Johnson, BC/BS will be submitting their own request that the exemption be granted. Dr. Johnson states: "Blue Cross/ Blue Shield of Florida has been very supportive and cooperative in everything that we (the FCA Committee) have requested of them, and they are supportive of our position on this exemption."

Through the Mercy Guidelines, and research demonstrating the efficacy and economy of chiropractic care, the FCA Medicare Committee is attempting to reveal the 12 visit screen as inappropriate for Medicare patients. If the FCA is successful in this endeavor, the chiropractic profession could win what may be the first of many Medicare exemptions.

Florida has one advantage: While the Mercy Guidelines are nationally developed, they are in the process of becoming administrative law to meet the requirements of the 1992 Florida Health Care Reform Act. This allows the FCA to insure that all chiropractors in Florida will be practicing under locally adapted guidelines.