May 8, 1990. Remember that date. That is the date the governor of Kansas signed into law the first legislation in the United States requiring Blue Cross and Blue Shield of Kansas to place a chiropractic physician on its board of directors. At least we are told by the general counsel for Blue Cross and Blue Shield of Kansas that this is the first such legislation in the nation. The profession can pat itself on the back. You have taken another step forward.
This idea came about when Blue Cross and Blue Shield pulled another one of its stunts. Last fall, Blue Cross and Blue Shield introduced something they called the Kansas Chiropractic Network. This was a program structured like a PPO which was specifically designed to reduce chiropractic utilization. You can imagine what chiropractors in Kansas thought about that kind of a program.
Of course, Blue Cross and Blue Shield thought it was perfectly justified in introducing such a program. After all, the allowed chiropractic dollars and therefore, chiropractic utilization had increased from approximately $3 million of allowed services in 1984 to over $12 million in allowed services from Blue Cross and Blue Shield in the calendar year of 1988. Blue Cross and Blue Shield thought that was significant. So did we. However, we view it as positive. Blue Cross and Blue Shield did not. Instead of recognizing the fact that more and more subscribers are utilizing lower costs, more efficient chiropractic treatment, Blue Cross and Blue Shield saw that chiropractors were taking away more of their dollars. Hence, the Kansas Chiropractic Network was born.
However, the Kansas Chiropractic Network did not come about overnight. It was over a year in the planning stages. In that one year's time, not one chiropractor in Kansas was ever consulted about the program. Blue Cross and Blue Shield specifically kept that program a secret. They did not even inform their own chiropractic consultant. This program, hatched under the cover of darkness, was presented to the Kansas Insurance Commissioner's office for approval. It was the Insurance Commissioner's office that wanted chiropractic input before approving the program. That is how we found out.
Once we heard about the program, we had plenty of arguments against it. I am certain you can imagine those arguments. I won't repeat them here. When Blue Cross and Blue Shield finally came to the Kansas Chiropractic Association board of director's meeting in early October of 1989, there was apparently no stopping this program. The Kansas Chiropractic Association's Board of Directors instructed me, as legal counsel, to research any legal means to halt the Kansas Chiropractic Network.
That is where this story started. In a careful review of the Kansas statutes relating to Blue Cross and Blue Shield the light bulb came on. It should have come on ten years ago when I started doing this work. I am glad it came on this time.
The light bulb was simply this: Blue Cross and Blue Shield is a creature of statute. If you can pass a statute, you can amend a statute. Therefore, instead of suing Blue Cross and Blue Shield, let's amend the statute to place ourselves on its board of directors. Let's get inside the board room. Let's get to the bargaining table. Let's get the information so they don't blindside us with another Kansas Chiropractic Network in the future.
That is exactly what we did. We drafted an amendment to the statute which required Blue Cross and Blue Shield to place a chiropractor on its board of directors. We went right over to Blue Cross and Blue Shield's offices and told them we were going to propose the statute. We didn't sneak around with it. We did not keep it a secret until the legislative session started. We showed it to them right up front. The beauty of this strategy is in its simplicity. Frankly, there are very few arguments that Blue Cross and Blue Shield can make to keep you off their board.
Blue Cross and Blue Shield has been contracting with chiropractic physicians for years. Yet, they are run by the allopathic and insurance establishments. What possible legitimate argument could they have for refusing to put a chiropractor on the board? In Kansas, the legislature has required that Blue Cross and Blue Shield's board of directors be made up of no fewer than 15 individuals. What harm can one chiropractor do?
Frankly, that was exactly the thinking of the legislature. That was not the thinking of Blue Cross and Blue Shield. They fought this amendment bitterly. They passed around literature to all of the members of the legislature concerning chiropractic. The literature was typically perjorative in nature. They accused chiropractors of trying to take over Blue Cross and Blue Shield for their own greedy ends. Happily, their strategy not only did not work, it failed miserably. After all, how could one chiropractor out-vote a 15-member board? What possible harm could one chiropractor cause? Why were they so afraid? These questions were never answered to the satisfaction of the legislators.
After extensive hearings which were delayed several times by Blue Cross and Blue Shield, the House of Representative passed this amendment by a vote of 119 to 3. The measure then went on to the senate. Once again, Blue Cross and Blue Shield attempted to stop the measure. They had it delayed on the calendar several times. When it finally came to a hearing in front of the senate committee, Blue Cross and Blue Shield argued against it again. During their testimony one senator asked the lobbyist for Blue Cross and Blue Shield the margin by which this measure had passed the house. Once that question had been answered, the senator responded by saying, "I only have one question for you then, Mr. Pitzenberger. Did you make the same arguments to the House of Representatives that you are making here to the senate?" Needless to say, the amendment passed out of the senate committee and across the senate floor by the same lopsided majority is received in the House of Representatives. The measure was signed into law on May 8, 1990. Congratulations!
While we are elated with these developments, we are also pragmatic. This is not a panacea. It will not cure all of the ill will between Blue Cross and Blue Shield and the chiropractic profession. It will not solve all of the problems of chiropractic in Kansas or in the rest of the country. Blue Cross and Blue Shield will no doubt continue to fight us on this issue. They may fight us administratively in selecting the chiropractor to serve on the board or in other ways we haven't even thought of yet. If you pass a similar measure in your state, it won't solve all of your problems either.
But this is a damn good first step toward solving a lot of problems. I urge you in your state association to take this step. Get to the board room. Get to the bargaining table. It can be done.
