ACA Champions H.R. 7157; ICA Voices Major Concerns
Dynamic Chiropractic Staff
| DIGITAL EXCLUSIVE
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations – to Congress urging swift passage of the Chiropractic Patients' Freedom of Choice Act of 2018, the International Chiropractors Association is "urging caution" on H.R. 7157 based on the language of the bill being "incongruent with promises made." Specific ICA concerns include the following:
HR 7157 inserts a 'qualifier' which will set the entire profession up to become 'aberrant billers'. Rather than leave the "manual manipulation of the spine to correct a subluxation" intact, the language included in the statement of purpose will become part of the notes section of the law and inserts "as demonstrated to exist" as a new, unnecessary and arbitrary qualifier for compensation not required of any other physician level provider.
[HR 7157] includes a provision to limit services reimbursed by chiropractors, who are determined to be aberrant billers on a quarterly basis. In essence, the promised expansion of coverage will be eliminated for anyone the Centers for Medicare and Medicare Services (CMS) determines to be over billing. This is a provision ripe for abuse by over-zealous Medicare administrators.
All important decisions on coverage specifics, including dates and timelines, are at the discretion of CMS personnel. As written, CMS may drag out the implementation for 3-5 years.
HR 7157 also ignores the request of the chiropractic community to be treated equally in Section 1395a of the Social Security Act provision on private contracting.
In its press release, the ICA concluded: "HR 7157 provides no guarantee that any expanded compensation will be provided in the near future. As currently written the ICA does not support HR 7157 and recommends caution to the profession regarding the language in the legislation. The ICA is in the final stages of crafting legislation that is practical, feasible and has a realistic prospect of passage."
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.
