How You Can Impact the Chiropractic Profession's Role in Health Care Reform

As election season moves into full swing this time of year, I am moved not only by observing true democracy in action, but also by the symbolic nature of new beginnings and new opportunities.

Our profession is at a crossroads – a "chiropractic spring," so to speak. Some would say that for 100 years, we have been an oppressed profession; one that has faced discrimination at almost every turn. Yet time and again, we have frustrated those who would have the chiropractic profession "wither on the vine." However, finally the community as a whole is seeing the damage caused by decades of a monopolistic and incestuous health care system.

It is now quite clear to those willing to have an open mind that change is the only option. Runaway costs, millions of uninsured, limited access and the overuse of pharmaceuticals and invasive procedures over the decades have brought us to a precipice that must no longer be ignored.

Let me be clear: I am not at all indicting the fabulous technological advances, the life-saving measures, and the almost-incredible ability to fight diseases that have throughout history caused worldwide epidemics and pandemics. Rather, what I see unraveling is the attitude fostered by the medical profession, and too often accepted by the public, that the traditional medical approach to health is the only answer for the ill and injured, or to obtain better health.

For years, as far back as the administration of Richard Nixon, the government has made attempts at reform. However, in recent years, with the cost of health care reaching almost 20 percent of our GDP, action needed to be taken. While President Obama's plan for reform moved forward through a most unusual path, it was signed into law. Clearly, there are concerns with a number of the provisions outlined in this 2,400-page law. Yet few would argue that as a result, many opportunities for an improved health care system are now also possible.

Included in the PPACA (Patient Protection and Affordable Care Act) are at least 26 sections on wellness and prevention. However, equally as important is the clause that eliminates the historical bias and discrimination experienced by virtually every non-MD provider practicing in this country. When enacted in 2014, this law will finally allow patients the freedom to choose, without artificial barriers, the licensed health care provider they feel is best qualified to provide their care.

All this sounds great for our patients, right? Well, not really. As we all know, the PPACA is being challenged by many states, legislators and candidates. In fact, the U.S. Supreme Court will be determining the legality of portions of the bill as early as this summer. In addition, virtually every Republican candidate for president has stated that they will sign an executive order on "day one" repealing "Obama Care."

To add to the complexity of the issue, the AMA, in one of its recent House of Delegates meetings, determined the removal of the anti-discrimination section I referenced above is among its top legislative priorities. (Not surprised? Me neither.)

I believe that most of us – Republican, Democratic or Independent – agree that the direction our health care system has moved in is simply not sustainable. We probably also agree that having the fox guard the henhouse (third-party payors) is certainly not in our patients' best interest. And we probably agree that the issue of 40 million uninsured people in this country needs to be addressed.

Given the high volatility of the situation, I believe we as a profession have only one option. As we are not large enough to create a change in the overall legal status of the act, I think it's our job to focus our effort on what we can affect: 1) the ability of a doctor of chiropractic to provide the services we are educated and licensed to perform; 2) to provide our patients the freedom, without discrimination, to choose our care if they so desire; and 3) to promote wellness and prevention as essential to any future health care system.

To that end, I am calling on each and every doctor of chiropractic to take an active role in the implementation phase of the health care reform process. The ACA, the Chiropractic Summit and many state associations worked tirelessly to include the services of doctors of chiropractic in many provisions of recent health care laws. As this was only a first step, each of us must begin to closely follow the implementation process of these provisions in our community. While doing so, we must monitor that the legislative intent is fulfilled and their removal by adversaries prevented. Below are some of the key provisions of which DCs should be aware:

• Become familiar with the development of ACOs (accountable care organizations), PCMHs (patient-centered medical homes) and insurance exchanges (state-directed insurance programs). [DC published articles on both of these topics recently. See "The Medical Home: Health Personalized" (Aug. 26, 2011 issue) and "Reaping the Rewards of Collaborative Care" (Dec. 2, 2011 issue).]
• Become involved with your local business community as an expert in prevention and wellness programs.
• Begin to use EHR ("meaningful use") by implementing the 2012 electronic health record incentive program in your office.
• Start using the Medicare-sponsored PQRS (Physician Quality Reporting System) quality measurement program for patients in your office.
• Improve your documentation of patient care.

You can learn more about each of these action steps by logging on to the American Chiropractic Association's Web site, www.acatoday.org. Time is of the essence! Not only will you be helping shape the future of health care in our county, but you may also be eligible to bring thousands of federal incentive dollars back to your practice.

As the election process proceeds, and if our doctors take the necessary steps, I believe we will experience a "chiropractic spring" this year. But just as in life, opportunities require action to obtain results. If you are the kind of doctor who avoids politics at all cost, you can still do your part by simply joining or maintaining your membership in the ACA, supporting the National Chiropractic Legal Action Fund ( NCLAF), the Chiropractic Health Advocacy and Mobilization Project (ChiroChamp.org; the profession's legislative action fund), and ChiroVoice.org, a grassroots patient organization.

If you like the idea of being involved, review the information on the health reform legislation, as well as the ACA and Summit positions on the new health care paradigm. Share them with your local candidates. Become engaged in a campaign. Get to know your candidate personally. Tell them your patients, who vote as well, want all of their providers to have a level playing field in health care.

Let them know that we must work towards the removal of historic bias against non-MD providers, such as chiropractic physicians. Remind them that doctors of chiropractic are cost-effective and achieve high patient satisfaction; and that there is abundant evidence supporting our conservative approach.

We are a market-driven society in which success follows equal opportunity. If this is the direction we go, the chiropractic profession will shine bright. Remember, inaction is as consequential as action.