It has been reported that members of the U.S. House and Senate are proposing the Chiropractic Medicare Coverage Modernization Act, ensuring reimbursement for all medically necessary services provided by chiropractors. However, the American College of Radiology and American Society of Neuroradiology have now joined over 90 other groups led by the AMA to announce their disapproval. They shared their concerns in a recent letter to the two bills’ sponsors, which ASNR promoted in an update published Tuesday.
“Our organizations are concerned that permitting chiropractors to bill Medicare for the full and likely expanded scope of their license in a given state will lead to an unnecessary redistribution of scarce Medicare resources,” the American Medical Association, all 50 state physician societies, ACR and ASNR recently wrote to lawmakers. Doing so, they added, will likely take funds from medical groups, redistributing them “to nonphysician practitioners for services that they lack sufficient training and expertise to perform. Such expansion would increase overall Medicare costs and jeopardize the health and safety of Medicare patients.”
Supporters of the bill claim the legislation would provide a path for Medicare recipients to better manage pain without resorting to opioids. Currently, the program only covers chiropractic care deemed “medically necessary, subjecting beneficiaries to “burdensome red tape requirements.” The Chiropractic Medicare Coverage Modernization Act seeks to remove these obstacles, bringing coverage rules more in line with rules imposed by private payers.
The radiology societies said they “greatly value the contribution of chiropractors.” However, they’re troubled the legislation would authorize them to use the title “physician” under the Medicare Part B program and be paid the same rate as MDs and DOs. Removing the current “manual manipulation” of the spine limitation in the program opens the door for chiropractors to provide other services “they have not been specifically trained to provide.” Physicians are required to complete upward of 16,000 hours of clinical training, while chiropractic students only must meet a minimum of 4,200 instructional hours.
“Given their relatively limited education and training, chiropractors’ scope of practice is appropriately restricted under Medicare to treatment by means of manual manipulation, i.e., by the use of the hands,” the radiology societies wrote. “This limitation is aligned with chiropractic training and the treatments that chiropractors most often provide involving common musculoskeletal complaints such as back pain.”
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Needless to say what I think about this bill! Chiropractors are not sufficiently trained in medicine, science or ethics to expand their services in the proposed way. One could, of course, train them to practice real medicine. Then most of them would probably give up spinal manipulation and become physicians like MDs.
This is the path that US osteopath have chosen a long time ago.
Would that be desirable?
No, I don’t see a point in having several different types of physicians. It can only confuse patients, lead to uncertainty and to suboptimal healthcare.
39 Responses to ‘Strong opposition’ to expanding Medicare coverage for chiropractic services
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Read the bill.
https://www.congress.gov/119/bills/s106/BILLS-119s106is.pdf
Interesting. They want to take away healthcare coverage from millions of poor people so that they can give the money they save to rich people, while at the same time giving a larger part of the money they DO spend on healthcare to quacks.
Those republicans really seem hell-bent on punishing poor and sick people for being poor and having health problems.
yes, I am afraid it feels very much like this.
Hm, correction: I just realized that this article is about Medicare, which mostly deals with elderly people and disabled younger people.
Medicaid is a different program, aimed at providing healthcare for low-income groups.
I understand that most of the cuts in the Big Billionaire Boost Bill pertain to Medicaid, not Medicare, while this quackery provision is only for Medicare at this moment.
Is it quackery to follow evidence-based guidelines?
Dr. Ernst: “Chiropractors are not sufficiently trained in medicine, science or ethics to expand their services in the proposed way. One could, of course, train them to practice real medicine. Then most of them would probably give up spinal manipulation and become physicians like MDs.”
2 comments:
Training chiropractors to practice “real medicine” is not likely since many of them simply don’t have the savvy to make it through medical school. That’s one of the reasons they become chiropractors – they get to be called “doctor” without really being a doctor.
As for ethics, that’s a concept that’s largely lacking in the chiropractic business. In my 40-plus years of investigation, I have seen countless examples of lack of ethics in advertising & in practice!
I agree – but I waas thinking long-term: one could start with new generations of chiros and make responsible docs of them.
Dream on, Dr. Ernst, dream on…
If they haven’t gotten any further along after 130 years, there isn’t a whole lot more we can expect from them except for more of the same.
This bill doesn’t expand services or scope. Those are governed by each state. What this bill purposes is to expand reimbursement coverage for things like exams (which Medicare requires us to do and to charge the patient).
As far as the AMA response, well, that appears mainly to try and confuse people in Congress.
Meanwhile, these reports are in the news:
https://www.atlantanewsfirst.com/2025/05/28/nearly-dozen-lawsuits-accuse-atlanta-doctor-deforming-faces/
and
https://nypost.com/2025/05/25/us-news/florida-doctor-arrested-for-allegedly-firing-gun-at-teens-who-tossed-cheese-at-his-range-rover-they-shot-at-me-first/
and
https://www.bbc.com/news/articles/c6265j321yeo
and
https://www.nytimes.com/2025/05/27/world/europe/joel-le-scouarnec-france-doctor-pedophile.html
and
https://www.wral.com/news/local/harnett-drug-fraud-hospice-may-2025/
and
https://www.justice.gov/opa/pr/south-carolina-man-charged-multimillion-dollar-medicare-fraud-and-ponzi-schemes
and
https://www.justice.gov/usao-edla/pr/slidell-doctor-convicted-health-care-fraud
Kurt, whenever you point a finger at someone, you are always point three back at yourself. Your comment about “countless examples” is purely anecdotal and unless you can reference, is not worth the paper it is written on.
Chiropractic therapy is not comparable with medicine, which deals with every type of illness and injury, of all acuity and severity, throughout the lifespan.
Chiro is manual therapy. Compare your results with other physical therapists and then consider where to “point the finger”.
@GibleyGibley
Thank you for this perfect example of whataboutism
Also note that while medical incompetence, negligence and crime are rare among real doctors, they are present in almost 100% of chiropractors – who as a rule do not have any proper medical education.
Good points. 100% of chiropractors who diagnose “vertebral subluxation” are guilty of misdiagnosis.
Not according to Medicare.
“…covers manual manipulation of the spine by a chiropractor to correct a vertebral subluxation…”
https://www.medicare.gov/coverage/chiropractic-services
— Dale Thompson (aka ‘DC’ et al.) on Chiropractic spinal manipulation is not safe!
https://edzardernst.com/2022/02/chiropractic-spinal-manipulation-is-not-safe/#comment-137611
Which is on in the light of this:
https://edzardernst.com/2023/02/a-young-womans-visit-to-a-chiropractor-left-her-unable-to-walk/#comment-144569
Sue Ieraci, reference please for the comment, ” 100% of chiropractors who diagnose “vertebral subluxation” are guilty of misdiagnosis”. Perhaps you should read books by Scott Haldeman D.C., M.D. PhD, before you make comments like this.
GibleyGibley,
If a chiropractor has misdiagnosed a client as having one or more chiropractic vertebral subluxations, how could it be shown beyond reasonable doubt that the chiropractor made a misdiagnosis of that client? Thank you.
Back to Medicare
“Medicare was billed for unnecessary procedures in 73.4% of cases. While it is not surprising that the federal government frequently pursues fraud charges when billed for unnecessary procedures, this percentage is high considering that Medicare covers only 16.9% of the U.S. population.”
https://pssjournal.biomedcentral.com/articles/10.1186/s13037-017-0144-y#Tab4
American Chiropractic Association or a similar chiro trade group confused people in Congress into writing that provision. But you already know that.
BTW….how have you been, DC? Busy I hope with research. Have you published any papers?
Richard Rasker please provide the evidence for the comment,
“Also note that while medical incompetence, negligence and crime are rare among real doctors, they are present in almost 100% of chiropractors – who as a rule do not have any proper medical education”.
Plentiful evidence of “lack of proper medical education” is littered throughout the cringeworthy comments on this website by chiropractors ‘GibleyGibley’, ‘DC’ [and its many other pseudonyms], and others.
Chiropractors are not medically qualified to even lance a boil and dress the wound.
Evidence to a SCAM practitioner is the equivalent of a lamppost to a drunk: it provides support rather than illumination.
@GibleyGibley
The evidence is mostly self-evident. But just to clarify things further, I’ll address both parts:
1: “medical incompetence, negligence and crime are rare among real doctors”: real doctors are not only required to complete at least 15,000 hours of education and internships before they are allowed near patients no their own, they are also required to regularly prove that they are knowledgeable and up-to-date in the field of medicine. If they fail any of these schooling requirements, they are no longer allowed to practice medicine. Also, there are systems in place for reporting and handling errors and problems.
As for crime rates: these will be comparable to those among the higher-income part of the general population.
So summarized: great efforts are taken to ensure that real doctors know what they’re doing, and that errors are reported, dealt with and learnt from.
2: “… they [medical incompetence, negligence and crime] are present in almost 100% of chiropractors”
Chiropractors are not required to complete an education even remotely as rigorous as real doctors. This alone makes them less competent in general to handle medical conditions than real doctors. And those who are educated to believe in the concept of subluxation are by definition fully incompetent and negligent, as their diagnostic and therapeutic skills are built on an imaginary phenomenon.
And even ignoring subluxations there is relatively little evidence for any efficacy of chiropractic treatments; at the very best, the results are comparable to those of physiotherapy. There are in fact strong indications that certain treatments, in particular neck manipulation, come with a small but real risk of very serious side effects, up to and including death.
To the best of my knowledge, no systems are in place for proper reporting and handling of errors that are comparable to those in real medicine.
Chiro’s are probably not inherently more criminal than real doctors, although I personally consider the ongoing use of neck manipulation criminally negligent, given the mounting evidence that this can seriously harm people without providing any proven benefits.
Richard Rasker, just to clarify the use of the title “doctor”. In countries where the medical qualification is a Bachelor of Medicine and a Bachelor of Surgery, “Real doctors” are those graduates that have a Doctor of Philosophy (e.g. Prof. Ernst), or a Doctor of Divinity or a Doctor of Laws.
Healthcare providers who use the title “Doctor” include Medical Practitioners (Susan Ieraci), Vetinarians, Dentists and Chiropractors. It is a title used as a courtesy, not a degree or qualification. If you look at the Australian Medical Council website, they refer to “medical graduates” or “medical practitioners”, not “doctors” as those people who can become registered. Your use of the term “real doctors” when referring to medical practitioner is incorrect.
Any particular reason for your capitalization of common nouns (other than pig-ignorance), ‘GibleyGibley’?
Perhaps Chiropractors of your status consider themselves to be better informed than chiropractors.
Regarding your inclusion of “Doctor of Divinity”:
https://edzardernst.com/2018/06/malpractice-of-chiropractors-just-the-tip-of-an-iceberg/#comment-103665
@GibleyGibley
Of course I’m using the designation ‘real doctor’ in an informal way for medical practitioners who completed a fully science-based and officially accredited medical education. This as opposed to what I call fake doctors, such as chiropractors and other SCAM practitioners who pretend to be able to deal with the same medical problems that real doctors are capable of handling.
It depends on the country whether or not ‘doctor’ is a protected title. Here in the Netherlands, chiropractors who use the title ‘doctor’ or ‘Dr.’ are committing title fraud and could be facing disciplinary sanctions. Chiropractors are not medical doctors, so pretending that they are by using the ‘Dr.’ title is misleading.
RR: who pretend to be able to deal with the same medical problems that real doctors are capable of handling.
I wonder, what percentage of chiropractors fall into this group?
While the answer is apparent to many of us, you may keep wondering….
Yes I wonder what percentage of chiropractors are going to treat something like Krabbe disease or Stoneman syndrome.
If you have a percentage backed by evidence, share it. Otherwise you’re just grandstanding.
did you forget that many chiros believe all diseases are cause by subluxation?
therefore, they would treat Krabbe disease or Stoneman syndrome with spinal adjustments.
I am just waiting for you to stop moving the goal post from ‘medical problems’ to specific genetic abnormalities. Perhaps you didn’t intend to move the goal post in which case it would appear you don’t even know what you are asking. I suggest you first make up your mind and then google the answer yourself. Even better, ChatGPT it and post the answer here.
chiro‑troll trolled “Yes I wonder what percentage of chiropractors are going to treat something like Krabbe disease or Stoneman syndrome.”
Regarding the latter…
“801 confirmed cases worldwide (2017); incidence rate estimated to be 0.5 cases per million people (1 in 2 million)”
https://en.m.wikipedia.org/wiki/Fibrodysplasia_ossificans_progressiva
Worldwide, there are circa 103,000 chiropractors — Stochkendahl (2019).
So, dear chiro‑troll, perhaps you will tell the readers the maximum percentage of chiropractors who could treat the condition if all chiropractors were willing to treat it.🙄
If you think those are the ones out there playing “real doctor” then you really don’t have a clue about the profession.
@DC
I have a list with all (200) Dutch chiropractors, and I’m working on rating the ‘quackiness’ of each.
ALL chiro’s that I investigated and rated (35 so far) turned out to be quacks:
– Many claim that they can treat (real) pediatric problems such as infant colic. They can’t.
– Several claim that they can diagnose and treat ‘KISS syndrome’, a non-existing condition, treated by yanking a baby’s neck and spine – which comes with VERY REAL dangers. This is nothing short of criminal IMO.
– Many claim that regular ‘adjustments’ benefit infants’ health. This is a lie.
– Many subscribe to the idea of subluxations.
– Some claim to be able to address neurological problems, often tinnitus, but also brain trauma.
– Some claim to be able to address hormonal problems.
– Some are dabbling in other kinds of quackery, such as thermography, laser therapy and hyperbaric oxygen therapy.
– …
NOT A SINGLE ONE of these chiro’s limited themselves to purely musculoskeletal conditions and treatments. Which puts them squarely in the quack category. All of them.
Richard. That’s fine to expose quacks. I don’t have an issue with that.
Regarding your selection.
“Non-NMS complaints are minimal (<2%)”
Chiropractic patients in the Netherlands: A descriptive study
Journal of Manipulative and Physiological Therapeutics
Volume 23, Issue 8, October 2000, Pages 557-563
“…no legal recognition of chiropractic education or protection of the title by the Dutch government…”
Practice characteristics of chiropractors in The Netherlands Clinical Chiropractic
Volume 8, Issue 1, March 2005, Pages 7-12
What’s changed in the last 20 years in that area of the world idk.
Yes I’ve come across some chiropractors that go beyond MSK conditions. They aren’t the traditionalist that Ernst alluded to. Rather they are the ones that are into the functional medicine approach.
But the majority I know stick with addressing MSK and don’t want to be seen as a MD because MDs typically aren’t very good with “simple” MSK issues.
Best wishes in your investigation.
“Your comment about “countless examples” is purely anecdotal…”
No, it’s observational, based on what I’ve seen over a 40 year span. I’ve never claimed that what I say is factual or demonstrable. But there are so many examples of chiropractic gibberish in evidence that only someone with personal ties of one sort or another refuse to admit that the field is rife with fraud, lack of ethics, pseudoscience, dangerous practices, anti vax views & general nonsense.
Granted that a few DCs have eschewed the original theory that disease is caused by the chimerical subluxation, but the business is, in general, tainted by that “original sin” dreamed up by D.D. Palmer.
Chiropractic consists of a hodgepodge of theories, treatments & internecine conflicts (as in “straights” v.s. “mixers”) most of which are at odds with the science-based medical mainstream.
I remember having read an interesting description of what constitutes chiropractic: “Chiropractic is what chiropractors do.” That pretty much includes, well, everything. If a chiropractor does it, it’s chiropractic!
Instead of griping about what is said against the business, you should refer us to actual scientific studies that substantiate pro-chiro claims. And, speaking of substantiation, I recommend that you read Professor Edmund Crelin’s 1973 paper on subluxations which leaves no doubt that there ain’t no such thing.
“Please remember: if you make a claim in a comment, support it with evidence.”
Apparently that’s too difficult for many of you folks.
Have you published any papers?
Dale has published as many papers as I have chiropractic awards [zero].
‘DC’ trolled above:
SCAM practitioners do (often inadvertently) treat clients who have one or more actual medical conditions; but the practitioners rarely treat the actual medical condition(s), because doing so would be tantamount to (depending on jurisdiction): quackery; charlatanry; practising medicine without a licence; health fraud; medical fraud. No indeed, SCAM practitioners treat only (a subset of) client symptoms — officially/publicly that is, but what the quacks say or imply to their clients behind closed doors is a different matter entirely.
E.g. a doctor who’s wearing a white coat and says “We’ve treated many patients with your condition.” implies to a non-medical client something completely different from the literal meaning of those words when they’re issued by a DC or ND.
‘DC’ wrote above:
For the benefit of the readers, perhaps someone with actual medical knowledge will be kind enough to list some “MSK conditions” that are beyond the remit of a chiropractor. Thank you.
(IIRC Frank Odds addressed this, but I can’t find his comment).