I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: "What is the ACA even doing?" Allow me the opportunity to share some factual information regarding the issues with Medicare and why it is so important that we overcome them, for our sake and our patients' sake.
In late April, the Chiropractic Summit unanimously approved a resolution to support a Medicare reform initiative, a nationwide call to action to once and for all eliminate the limited access to the essential services provided by doctors of chiropractic in this nation's largest health insurance program. The Chiropractic Summit, made up of chiropractic organizations (including the ACA and ICA) and prominent business partners, looked inward and vowed to grow public support to help eliminate the discrimination faced by chiropractic patients in Medicare.
Arbitrarily Limited
The chiropractic profession's inclusion in Medicare, which dates back to 1972, is defined by an antiquated statute [Section 1861(r)] of the Social Security Act. Unfortunately, the inclusion is both written and interpreted by CMS regulators in such a way that imposes an arbitrary limitation on the services doctors of chiropractic are allowed provide or order for their patients.
There is no scientific or valid policy basis for this purely arbitrary limitation that exists within Medicare as it relates to chiropractic services, and no other health care providers are subject to this type of restriction. These limitations do not allow chiropractic physicians to practice to the extent of their training or licensure.
Blatantly Anti-Competitive
As currently written and interpreted, existing statutory language favors an anti-competitive provisioning of Medicare services by "competitor" providers such as MDs and DOs. These providers experience an artificial market advantage over DCs, who are not allowed to furnish existing covered Medicare services that fall within their scope of practice.
The artificial limitation that restricts DCs to providing a single service – manual manipulation of the spine – serves to channel patients to other providers who, for all practical purposes, are provided a "franchise" to offer Medicare beneficiaries a range of services that DCs are not allowed to compete to offer in the Medicare beneficiary marketplace.
Not in the Best Interest of Patients
Because current policy toward chiropractic services is anti-competitive, patients are, in effect, channeled to other providers whose standard treatment regimen involves the use of drugs, spinal injections and surgery for a range of spinal conditions. The services provided by doctors of chiropractic are a less costly and safer alternative for many conditions, helping patients to avoid the use and dangers of drugs (opioids in particular) and unneeded spinal surgeries and injections.
Spinal-related pain is widespread in society – and especially among Medicare beneficiaries – and Medicare policy should seek to prevent the use of unnecessary drugs and surgery in a population that is already at higher risk than society at large. To the extent current policy arbitrarily restricts access to chiropractic services, it exacerbates these problems.
What's Being Done and How You Can Help
To help build public support for the Summit-approved initiative, the ACA has developed the National Medicare Equality Petition, a grassroots effort to eliminate a blatantly anti-competitive provision of Medicare law that arbitrarily limits reimbursement for medically necessary services delivered by doctors of chiropractic.
To be clear, this is not an ACA vs. ICA issue. This is not a "straight vs. mixer" issue. This is about the ability of all chiropractors across the country to serve Medicare patients to the extent of their licensure – on an even playing field with other health care disciplines.
I strongly encourage DCs across the country to recruit the active support of patients and other chiropractic supporters to sign the petition and add their names to a growing list of Americans who demand coverage for all services provided by chiropractic physicians for the Medicare population.
Doctors and patients who wish to support the campaign may add their names to the National Medicare Equality Petition by visiting www.acatoday.org/equality. In my office, I also have handouts to give to my patients so they can log on and sign the petition, as well as a sheet at the front desk they can sign and we will enter the information for them.
You also can follow the progress of the campaign and receive updates on Facebook, and follow on Twitter and Instagram (#MedicareEquality).
This is important to all of us. Please get on board and support your profession. Again, this is about leveling the playing field so we can serve our patients – without discrimination – to the scope of our licensure and with the ability to use our resources to the benefit of the Medicare community.
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