Manitoba is the only remaining Canadian province that covers a portion of chiropractic care for all residents, but a new funding formula effective June 1 cuts $4.8 million from Manitoba Health's annual subsidies for chiropractic, reduces the allowable number of visits to a DC from 12 to seven per year, and lowers the per-visit coverage amount from $12.30 to $8.29. (On April 1, 2018, coverage will increase to $10 per visit, but still significantly lower than previously.)
Note that this coverage amount is for the chiropractic adjustment only, according to the Manitoba Chiropractors Association (MCA), and "does not include other services such as the examination, re-examination, x-rays, consultation, general information on exercises or nutrition, or other therapies used to support the chiropractic adjustment."
In an article in the Canadian Chiropractor reporting on the cuts, Dr. Greg Stewart, a spokesperson for the MCA, emphasized the funding scale-back "flies in the face of the national opioid strategy. ... Although we have the provincial government signing on to the federal government's national opioid strategy about improving access to nonpharmacological care, at the same time within months of each other, they decrease access for the same nonpharmacological care. It's hard to understand."
Longtime readers of Dynamic Chiropractic will recall that Ontario delisted chiropractic as a partially covered service in 2004, and Alberta followed suit in 2009, leaving Manitoba as the sole Canadian province offering any measure of chiropractic coverage for all residents. One wonders whether the provincial government's next cost-saving step will be to remove chiropractic entirely from Manitoba Health. Stay tuned.
While cervical disc pathology can unquestionably produce radiculopathy, many patients presenting with arm pain, paresthesia or perceived weakness do not exhibit the clinical behavior of true nerve-root compromise. In these cases, failure to differentiate the primary pain generator may lead to unnecessary spinal injections, nerve ablation procedures or surgical consultation despite limited likelihood of benefit.
The New Jersey Board of Chiropractic Examiners has made a precedential decision, concurring with the Association of New Jersey Chiropractors' (ANJC) position paper on chiropractic X-ray guidelines. In plain terms, the board ruled, consistent with the ANJC position, that insurance companies cannot use medical X-ray rules or recommendations, like those written by the American College of Radiology (ACR), to decide whether a chiropractor's X-ray was necessary.
For decades, chiropractors have been told the answer to more professional referrals is simple: educate medical doctors about chiropractic. There is some truth in that advice; but it is also incomplete. The modern challenge is not simply getting another healthcare professional to know that chiropractors exist. It is becoming the kind of clinician (and building the kind of professional relationship) that makes collaboration easy and sustainable.
