As a state delegate for the American Chiropractic Association, I have been able to attend the annual National Chiropractic Leadership Conference (NCLC), discuss the major issues, meet with legislators and promote the profession. I can tell you personally there are people "up on the Hill" promoting the chiropractic message. Regardless of the internal debates plaguing chiropractic, I think we can all agree people need our care. The 114th Congress opened in January of this year, and the ACA has been heavily involved in the legislative process since day one. Let's look at some of the issues currently on the table and the legislation that can change things for he better.
The NHSC: Why No DCs?
The National Health Service Corps is comprised of a range of health care professionals who help provide badly needed health care services in a variety of geographic areas across the nation known as "HPSAs" (Health Professional Shortage Areas), a designation determined in conformance with Section 332 of the Public Health Service Act. In addition to designated geographic areas, a number of individual facilities are also designated as HPSAs, typically federally qualified community and rural health care centers.
To help locate health professionals in those areas where a documented shortage of health professionals has been determined to exist, the National Health Service Corps manages a loan repayment program and a scholarship program for which certain types of health care providers are eligible to apply. These programs offer important levels of financial assistance (typically up to $50,000) to repay student loans and expenses associated with obtaining an eligible health provider's degree, in return for practicing in a designated HPSA or site for a two-year period. In some circumstances, these programs are able to provide additional loan repayment funds for service beyond the initial two-year period.
Types of health care providers that qualify for these programs include allopathic and osteopathic physicians, nurse practitioners, certified nurse midwives, physician assistants, dentists, registered dental hygienists, health service psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, and psychiatric nurse specialists – but not doctors of chiropractic.
Despite being primary care portal-of-entry providers licensed in all 50 states to treat a wide-range of health care conditions, including widespread spinal maladies, DCs currently are not specifically designated as eligible to participate in the NHSC programs. The population of patients living in designated HPSAs or receiving care through designated HPSA sites are every bit in need of the important nonsurgical, nonpharmaceutical services provided by doctors of chiropractic as are patients living in non-HPSAs.
Key Legislation in the Pipeline: Representative Gregg Harper (R-Miss.) has introduced HR 542, bipartisan legislation that would amend the Public Health Service Act to designate that doctors of chiropractic are eligible to compete in the NHSC loan repayment and scholarship programs. As of press time, HR 542 has been referred to the House Subcommittee on Health.
HR 542 is "budget neutral" and as such, adds no new costs to the federal budget – as it would allow DCs to be eligible to compete for a share of those overall funds available within the ongoing loan repayment and scholarship programs.
TRICARE: More of the Same
Another issue ACA is working on revolves around further integrating the services provided by DCs for civilians in the military health care delivery setting. In recognition of the value and benefits of the services delivered by doctors of chiropractic, in 2000 Congress enacted into law a permanent chiropractic benefit within the DoD health care system for active-duty military personnel (Section 702 of Public Law 106-398). Similarly, Public Law 107-135, enacted in 2001, provided for the availability of chiropractic care within the Department of Veterans Affairs (VA)health system. Medicare beneficiaries also have access to the services delivered by doctors of chiropractic, as do federal employees through the largest Federal Employees Health Benefits (FEHB) plan.
The essential services provided by DCs are now available to active-duty troops at 60 military treatment facilities in the United States and at bases in Germany and Japan. The availability of the services delivered by in these settings is due to the continued and growing recognition by the public and policymakers that the services delivered by DCs are proven, cost-effective and desired components of our nation's health delivery system.
Unfortunately, Congress has not yet acted to ensure the services delivered by doctors of chiropractic are available to retirees, dependents and survivor beneficiaries in the military TRICARE system. During the Chiropractic Demonstration Program at the DoD sites prior to enactment of Section 702 of Public Law 106-398, dependents and retirees were provided with services delivered by DCs on a space-available basis. By all accounts, the response to such access and services was overwhelmingly positive and effective.
This inequity has resulted in medically retired servicemen and women losing their chiropractic benefit immediately upon discharge. Many wounded warriors who depended on the services provided by doctors of chiropractic, suddenly have that treatment option pulled out from under them when they are categorized as "medically retired."
Key Legislation in the Pipeline: Reps. Mike Rogers (R-Ala.) and Dave Loebsack (D-Iowa), have introduced HR 802, bipartisan legislation to provide TRICARE recipients with a benefit that is now available to many in the private sector: access to doctors of chiropractic and services to address pain management, neuromusculoskeletal disorders and related maladies. As of press time, HR 802 has been referred to the House Committee on Armed Services.
Other Signs of Progress
Recently, the Joint Commission, an independent, nonprofit organization that certifies more than 20,000 health care organizations and programs in the U.S., including every major hospital, revised its pain management standard to include chiropractic services. Clinical experts in pain management who provide input to the commission's standards affirmed that treatment strategies may consider both pharmacologic and nonpharmacologic approaches. Services provided by doctors of chiropractic (who were recognized in 2009 as "physicians" by the commission) are now included in the standard of care for pain management, effective January 2015.
The treatment plan offered by DCs is a nonpharmacologic approach to pain management, of course. The Joint Commission standard advises facilities, when considering the use of medications to treat pain, to weigh both the benefits to the patient, as well as the potential risks of dependency, addiction, and abuse of opioids.
Make a Legislative Impression
Doctors of chiropractic, CAs and chiropractic students are urged to contact their federal representatives and request they cosponsor HR 542 and HR 802. The ACA has made this easy, as all anyone needs to do is go the ACA Legislative Action Center, where you can contact your congressional leaders with just a few mouse clicks. The more cosponsors we have, the better the likelihood of success, so I implore you to urge your legislators to support chiropractic patients and cosponsor these bills.
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