The Consolidated Appropriations Act of 2018, signed by President Trump in late March as the U.S. government faced the latest threat of a temporary shutdown, includes a provision requiring the U.S. Department of Veterans Affairs to expand the availability of chiropractic services at two or more medical centers in each of the 21 Veterans Integrated Service Networks (VISNs) no later than Dec. 31, 2019 and at 50 percent or more of all medical centers in each VISN by Dec. 31, 2021.
The victory comes after a decade of annual legislative attempts to expand chiropractic services in this manner within the VA health care system. Veterans currently have access to chiropractic services at approximately 70 VA medical centers within the 21 VISNs, but nearly 100 centers remain without chiropractic.
The $1.3 trillion omnibus appropriations bill (H.R. 1625) also expands chiropractic scope of practice within the VA courtesy of an important code change. The legislation amends the Veterans Benefits title of the U.S. Code to include "chiropractic services" in the definition of both medical services and rehabilitative services, while "chiropractic examination and services" is added to the definition of preventative health services.
Chiropractic could have achieved an even bigger victory within VA Health if not for last-minute changes to the legislation. Veterans Choice reforms were originally slated for inclusion in the omnibus appropriations bill and would have allowed certain veterans (those who do not live close to a VA medical center, face challenges in reaching a center, would have to wait more than 30 days for an appointment at one, etc.) direct access to health care practitioners, including doctors of chiropractic. However, the reforms never made it into the final bill.
Editor's Note: This is already shaping up as a good year for chiropractic in the Veterans Health Administration and Department of Defense. In March, we reported on the passage of the Jobs for Our Heroes Act (S.B. 1393), which makes DCs employed by the VA eligible to perform commercial vehicle medical exams. And as reported in our April issue, the Chiropractic Health Parity for Military Beneficiaries Act (H.R. 4973), introduced in February and currently under review by the House Subcommittee on Military Personnel, would give military retirees, their dependents and survivors access to chiropractic care services and benefits within the DoD's TRICARE program. Stay tuned!
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
