MD, PhD, FMedSci, FSB, FRCP, FRCPEd

On their website, the American Chiropractic Association (ACA) recently updated its members on their lobbying activities aimed at having US chiropractors recognised as primary care physicians. The president of the ACA posted the following letter to ACA members:

Last February the ACA House of Delegates passed a formal resolution directing ACA to make achieving full physician status in Medicare a top priority of the association.

For much of this past year, ACA’s staff and key volunteers have been laying the groundwork to achieve just that — quietly spending time building key support on Capitol Hill for this important legislative change. As you know, our progress advanced to the point where we were able on Oct. 27 to publically launch our grassroots campaign centered on the widespread circulation of our National Medicare Equality Petition.

Since the launch of our campaign, through very public and transparent means, ACA has received the support of various organizations and individuals within the profession. These supporters fully understand the importance of eliminating any and all provider discrimination by CMS. Further they fully understand and agree with the soundness of the strategic and tactical decisions we have made and continue to make an effort to achieve the desired reformation in Medicare.

Towards building a unified consensus within the profession for our objectives and plans to accomplish them, we have engaged in prolonged discussions, mostly via the Chiropractic Summit Steering Committee and Roundtable process that includes ACA, COCSA, ACC, ICA, NBCE, FCLB and CCE. Throughout this process we have provided for them written legal opinions and analyses relative to the precise legislative language needed to achieve the full-physician status we seek. We have outlined our strategy numerous times; have shared our materials and updates with any group wishing to review them; and have repeatedly urged state chiropractic associations, chiropractic colleges, corporate partners and individual DCs to join with us and enthusiastically support this reformation campaign.

While there was high consensus on the objective of Medicare reform during the Summit Roundtable process, there was much discussion surrounding the proposed legislative language. Specifically, whether or not “detection and correction of subluxation of the spine through manual manipulation” would need to be eliminated and replaced with language simply designating DCs as physician level providers on the same level as MDs and DOs who report/bill services to Medicare based on their individual state laws.

ACA is of the opinion that nothing less than removal of the “subluxation” language in the definition of physician section will accomplish our objectives. Historically, the facts are that this language has proven to be the major barrier within HHS and CMS when we advocated for regulatory remedies expanding our reimbursement and coverage for the full range of services provided by a DC. ACA (and our profession) has expended massive resources over the past decade or longer to no avail through regulatory channels (HHS, CMS). Based on these experiences, the only reasonable recourse to eliminate 40+ years of Medicare discrimination is through a thoughtful profession-wide legislative effort.

During the Roundtable discussions, compromise language was reached placing the current “subluxation language” into the preamble of a proposed law stating that DCs must continue to have the ability to detect and correct subluxations of the spine for Medicare beneficiaries. Six of seven Summit Roundtable organizations voted in favor of this language that was offered by the Association of Chiropractic Colleges.

ACA`s intent on removing the “subluxation” reference in the Social Security Administrative statute is in no way an attempt to quash our ability to perform those services that so many of the Medicare population need and deserve. Rather, the ultimate goal of this historic effort is to gain the privilege to manage our Medicare patients within state scopes of practice and allow reimbursement for all those services that the Medicare beneficiaries are currently forced to pay out of pocket. ACA supports fully our continued ability to correct subluxations through appropriate active care and, in fact, achieve coverage for manipulation of all areas, not simply limited to the spine.

Expanding Medicare scope reimbursement will allow our profession to practice contemporary chiropractic and to potentially increase utilization of our services to the ever-increasing aging population. Expansion and reformation will also place DCs in a position to participate in alternative payment models, quality healthcare initiatives, community health centers, hospitals and other integrated settings which are vital to professional growth.

In conclusion, should you as an HOD member be questioned on our intent you should be able to answer unequivocally that ACA supports the right to manage our patients as dictated by our training and competencies based on state scopes of practice. Further, we support those who wish to provide necessary active subluxation care for the Medicare population. Please support this initiative and let’s join together to encourage your state association, colleges and universities, corporate partners, patients and individual DCs to become true partners in order to make this a success for our patients and for our grand profession.

A list of talking points will be distributed in the coming days.

Sincerely, Tony Hamm, DC President, ACA

Do I read this correctly?

The term subluxation is a hindrance to business. Therefore chiros need to do something about it. Never mind that the principle of subluxation as used in the realm of chiropractic is nonsense!

This might throw an entirely different light on those chiros who want to get rid of the term ‘subluxation’.

And what about chiros as primary care physicians?

Recently Dave Newell posted on this blog: “chiropractors in the UK … are primary care clinicians”. I objected and he insisted to be correct because “Primary Care is defined as a clinician that is the first port of call for patients seeking help.” Frank Odds then countered: “This business of “primary care provider” is becoming enervating! Edzard has now spelt out the meaning of the term as defined by Wikipedia. You are quite right that a dentist is a primary care provider: people go to a dentist when they have symptoms affecting their mouth in general — more often their teeth and gums in particular. They know that’s what dentists deal with. A general practitioner is a primary care provider: people go to a GP when they have symptoms anywhere. They know that’s what GPs deal with. A chiropractor is indeed a primary care provider: of chiropractic. ”

I think that primary care physicians are doctors who are capable of handling everything or at least most of what primary care may present to them. Chiros do not fulfil this criterion, I think.

I would be interested what you feel on this important issue.

5 Responses to US chiropractors want to be recognised as primary care physicians

  • There is only one standard of ‘primary care physician’ in the UK – one who is registered by the GMC as being a ‘registered medical practitioner’.
    The GMC also allows that latter designation to those on its register of specialists and those who are on its general register such as trainees, SAS doctors etc. (GP is now regarded as a specialism in its own right.)

    The GMC was founded in 1858 to protect patients.
    Practitioners of any description who cannot or do not meet the standards for full registration cannot style themselves ‘RMP’.
    That is how standards are maintained.

    Practitioners who want the status of being a medical doctor (physician in the US) should qualify as RMPs. After which they can train and practice as chiropractors if they wish. Just as I trained and practiced as an orthopaedic surgeon. (In the UK, the designation of ‘physician’ more usually reserved for specialists).

    Any other course of action must inevitably lower the standards of ‘medicine’. That is unacceptable. Perhaps that is the intention of those chiropractors who have not qualified in medicine.

    It is the case that some students who aspire to enter a healthcare profession believe in the philosophy, principles and practice of chiropractic. Fair enough. (If they did not, why would they seek to become ‘chiropractors’?) But they should not believe that they have the same qualification as RMPs and certainly should not mislead patients into believing they have.

    I have personally worked with nurses, physiotherapists, and many dentists who have gone on to qualify as RMPs. It may not be easy, but I reiterate, that is how standards are maintained.

    If US regulators of medicine are prepared to see standards lowered, just to enable marketing and financial benefit of practitioners who have not qualified in medicine, so be it. The important thing for patients around the world is to understand what is going on with these regulatory issues, and to give fully informed consent to any proposed treatment, with that understanding.

  • Do I read this correctly?
    Yes, I fear that you are. From my notes while reading the quote and before reading your question.

    So, am I reading this correctly? They are saying that a central tenet of chiropractic is nonsense? Or just suggesting some “selective editing” ?

    This looks very dubious. And just how does one bill for the “detection and correction of subluxation of the spine through manual manipulation” if it is not a defined billing category under Medicare?

    Of course the program could be two-step: First get primary care status and then campaign to get “detection and correction of subluxation of the spine through manual manipulation” introduced as a billable item under Medicare.

    If the US congress or whoever is stupid enough to give primary care status to chiropractors the second step would be child’s play.

    One presumes once once has Medicare approval most private insurance will feel obliged to provide equivalent coverage?

  • It would benefit mankind if organizations as American Academy of Family Physicians, the AMA, the American College of Pediatricians and Internal Medicine would be informed of this information, since congress needs to hear the truth from reliable sources.

  • The ACA doesn’t care a whit about what is best for patients. What is important for them is expanding scope of practice in a cult that is finding it difficult to support all of its practitioners. Veterinarians would make much better primary care physicians than chiropractors. It would be best for the public for chiropractic to simply disappear.

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