Department of Health and Human Services Policy Letter Spells Major Victory for ACA and DCs
- Tuesday, February 26, 2002 by newsmanager
ARLINGTON, VA - The Department of Health and Human Services (HHS) has issued a new policy directive that under Medicare+Choice, nonphysician physical therapists cannot provide manual manipulation of the spine to correct a subluxation. The directive is a major victory in the American Chiropractic Association's lawsuit against HHS to prohibit non-DCs from providing manipulation of the spine to correct subluxations under the Medicare program.
In a January 15, 2002 revision to an "operational policy letter" originally issued in 1994, Medicare's Center for Beneficiary Choices writes: "The (Medicare) statute specifically references manual manipulation of the spine to correct a subluxation as a physician service. Thus, Medicare+Choice organizations must use physicians, which include chiropractors, to perform this service. They may not use nonphysician physical therapists for manual manipulation of the spine to correct a subluxation." (Emphasis added.)
"The ACA is extremely pleased that Secretary Tommy Thompson and his department have formally recognized the unfairness and injustice to doctors of chiropractic and their patients that the 1994 operational policy letter imposed," said ACA Chairman Dr. James Edwards. "We will continue the ACA's lawsuit to guarantee that no one other than doctors of chiropractic can deliver the chiropractic service since only the issue of illegal use of physical therapists has been resolved," he added.
The ACA filed its lawsuit November 9, 1998,1,2,3,4 claiming that HHS guidelines unlawfully allowed Medicare managed care plans to substitute the services of other health care providers for services that should have legally been performed by doctors of chiropractic. Specifically challenged in the ACA's lawsuit was the 1994 operational policy letter (now revised by the January 15, 2002 policy letter).
A report filed with Congress by the Office of the Inspector General (OIG) on January 13, 1999 showed that 29 percent of the Medicare managed care plans were using physical therapists to provide manual manipulation to Medicare enrollees under the 1994 policy letter.5 The study also revealed that of the four Medicare managed care organizations surveyed, their average percentage of beneficiaries receiving chiropractic care was only 1.55 percent. This was down sharply from the Medicare fee-for-service utilization of 4.15 percent.6
"The infamous policy letter (of 1994) gave the green light to Medicare HMOs to misappropriate taxpayer dollars to pay nonphysician physical therapists to deliver the chiropractic physician service of 'manual manipulation of the spine to correct a subluxation,'" explained ACA President Dr. Daryl Wills.
The issuance of the revised policy letter follows seven years of intense, but futile, negotiations between ACA and the prior Secretary of HHS, Donna Shalala.7 Those negotiations culminated in the ACA's lawsuit filed against her and her department more than three years ago.
ACA representatives say they will vigorously monitoring managed care organizations to see that they fully comply with the new directive and the law in providing chiropractic services to the nation's senior citizens. If not, ACA representatives say they will take, or encourage the taking of, legal steps to ensure compliance. The ACA will also continue to pursue the other counts in its ongoing lawsuit with HHS pertaining to the improper provision of the chiropractic service by medical doctors and doctors of osteopathy.
A complete copy of the operational policy letter can be found at: www.chiroweb.com/opl.
Medicare is the federal health insurance program for people 65 years of age and older, and some disabled people under 65. It is administered by the Centers for Medicare & Medicaid Services (CMS), formally the Health Care Financing Administration (HCFA). Medicare is the largest health insurance program in the U.S. (covers 39 million Americans).
There are two Medicare programs:
The original Medicare plan (a certain amount of hospital coverage is paid; patients pay deductibles and a percentage of the cost for private fee-for-service);
Medicare+Choice plans, which include:
managed care plans private plans
Both programs have two parts:
Part A (hospital insurance) - most seniors don't pay for Part A
Part B (medical insurance) - Under Medicare+Choice plans, most seniors pay a monthly fee (about $54 per month) Part B covers doctor services, outpatient hospital care, and health care services that Part A does not cover, such as chiropractic, physical and occupational therapy, and some home health care. Part B helps pay seniors for these services that it deems medically necessary.
Blue Cross/Blue Shield Offers Chiropractic Discount
- Monday, January 28, 2002 by garyfarr
Blue Cross / Blue Shield of North Carolina (BCBSNC), the state's largest health insurer, is making chiropractic services available at a 25% discount to its customers through the insurer's alternative medicine discount program, Alt Med Blue.
The program includes 400 chiropractors, among other practitioners. The insurer is offering the discount because, in the words of Dr. Robert Harris, chief medical officer at BCBSNC: "Chiropractic care is among the most frequently used complementary treatments."
Florida Chiropractic Association Joins American Chiropractic Association's Medicare Lawsuit
- Monday, January 28, 2002 by garyfarr
The Florida Chiropractic Association (FCA) Board of Directors voted in early 2000 to involve itself in the American Chiropractic Association's ongoing Lawsuit against the U.S. Department of Health and Human Services concerning the new Medicare Part C regulations. These regulations are part of the government's new managed care plan that allows DOs and MDs to perform spinal manipulations in lieu of chiropractors. ACA President James Mertz, DC, DACBR, welcomed the FCA's participation in the lawsuit: "Florida is a state where treatment of the Medicare population is a vital concern for the chiropractic profession. Both the FCA and ACA want to ensure that these Medicare beneficiaries receive the chiropractic care they are entitled to under the law."
Chiropractic: It's Not Just for Backs Anymore
- Monday, January 28, 2002 by garyfarr
For a long time Chiropractors, and most chiropractic patients have known that Chiropractic treatment is effective for many things other than treatment of the musculoskeletal system. In fact, a chiropractor, in many ways, is the ideal first stop for any patient. Chiropractors are educated to focus on wellness rather than disease, are trained extensively in diagnostic skills, and as more and more research is indicating, chiropractic methods, can often effectively treat a wide range of problems beyond back pain. Further, all of these treatment techniques are drug-free and noninvasive.
A recent edition of Chiropractic Research Review (1998) summarized a number of recent research investigations, that indicated that Chiropractic treatment can significantly improve a wide range of physical problems. Among the findings were:
218 patients diagnosed with migraine headaches were randomly assigned to spinal manipulation, amitriptyline (migraine medication), and spinal-manipulation-plus-therapy conditions. Patients in all three groups improved significantly over the course of treatment, but there were not statistically significant differences among the groups in the four week treatment or in a four week follow up. Thus, this study indicated that chiropractic manipulation is comparable in effectiveness to treatment with amitriptyline, or the combination of both. (Nelson et al., 1998)
17 patients suffering from visual field loss (concentric narrowing of the visual field) were treated with chiropractic manipulation Ten of the seventeen experienced complete recovery and the majority of the other patients experienced significant improvement. This study was particularly interesting since, traditionally, this type of visual field loss is attributed to hysteria. (Stephens et al., 1998).
A pilot study with nine patients found a measurable reduction in salivary cortisol levels over six weeks of treatment. Cortisol is the hormone most associated with the stress response, and implicated as playing an important role in many stress related health deficits (Stephens et al. 1998).
Alternative Medicine Increasing in Popularity in U.S.
- Monday, January 28, 2002 by newsmanager
So-called "alternative" medicine – much of which has been in use elsewhere in the world for thousands of years -- is an increasingly popular alternative here in the U.S., new research from Harvard University indicates. In a recent report, researchers there found that a growing number of people – of all ages, ethnicities, geographic areas and education levels – are using at least one of 20 common traditional medicine techniques, including acupuncture, herbal medicines, yoga, massage.
Their study looked at use of traditional therapies over the past 50 years. The findings are based on more than 2,000 telephone interviews conducted in 1997 and 1998 and are published in the August 21 issue of the Annals of Internal Medicine.
In the study, says an article from Reuters Health, almost 70% of adults said they'd used at least one traditional medicine therapy at some point. Not surprisingly, younger respondents were more likely to have tried one. For example, 70% of respondents born between 1965 and 1979 had used a traditional medicine therapy by age 33. Half of respondents born between 1945 and 1964 made the same claim, as did just 30% of those born before 1945.
Across all age groups, use of traditional medicine therapies is on the rise since the 1950s, however, and the biggest spike in utilization occurred in the 1960s and 1970s. Almost half of respondents who've tried a traditional medicine therapy reported still using it as much as 20 years later.
Interestingly, aromatherapy, herbal medicine, massage and yoga were reported as the most popular therapies in the 1990s, while biofeedback, energy healing and imagery topped the popularity list in the 1970s. The National Institutes of Health have set up an office dedicated to clinical trials on a variety of traditional medicine therapies.
The take-home lesson? ``These results should dispel any suggestion that use has increased for only singular complementary or alternative modalities or that the use of complementary and alternative medicine therapies is a passing fad associated with one particular generation or fringe segment of the population,'' says Harvard Medical School's Dr. Ronald C. Kessler. ``These responses imply that complementary and alternative therapies are perceived to be a force to be reckoned with for some time to come."
Still, he says in the journal report, ``you can't make recommendations because the therapies are, by definition, unproven."
Source: Reuters Health
Our Comment: Funny that Chiropractic wasn't mentioned in this article, when more people see chiropractors than any other "alternative" method.
New Cervical Adjustment and Stroke Data Published by the Canadian Medical Journal
- Monday, January 28, 2002 by newsmanager
Haldeman, Carey and Popadopolous have recently published an article addressing the incidence of stroke following a cervical adjustment in the Canadian Medical Association Journal (CMAJ).
The study was based upon the claims experience of the Chiropractic Protective Association of Canada, the profession’s main source of professional liability coverage in Canada. The likelihood of stroke following a chiropractic intervention was stated as follows:
-- 1 per 8 million chiropractic office visits -- 1 per 5.85 million cervical adjustments -- 1 in the career of every 48 chiropractors -- 1 in every 1,430 practice years
The incidence was dramatically less than the reports offered in other publications of 1 per 500,000 to 1 in 1,000,000 million adjustments. The likelihood of a stroke reaction to an adjustment was viewed by all parties involved to be rare.
The article also reviewed the circumstances of the 23 persons in the past 10 years that have experienced a CVA following an adjustment. As previously reported by Haldeman et al., there were predisposing factors identified that would be of use to the chiropractor or the patient. The average age of incidence was higher than had been previously reported at 42.5 years.
Our congratulations to Scott Haldeman and Paul Carey in particular for their efforts on this paper and for the great use of important proprietarily held data.
Our comment: This recent research indicates that receiving chiropractic care is very safe. Your chance of sufferering adverse effects from chiropractic care is less than the chance of you being hit by lightening.
Palmer Approved to Open Florida Campus
- Monday, January 28, 2002 by newsmanager
On Sept. 20, the Palmer Chiropractic University System Board of Trustees held a special teleconference meeting and gave final approval to a Palmer college in Port Orange, Fla. Following that meeting and an appearance Sept. 25 before the Florida State Commission for Independent Education, the Palmer Chiropractic University System was awarded Level 1 provisional licensure. The licensure is granted for a period of up to 12 months and means Palmer may begin advertising, recruiting, enrolling students, collecting tuition and fees and holding classes at its Port Orange campus.
"This level of licensure is a green light for us to proceed with recruitment and accelerate our facilities plans for Palmer College of Chiropractic Florida in Port Orange," said Palmer Chiropractic University System Chancellor Michael E. Crawford. "We are gratified by this vote of confidence by the Florida Commission, and we are proceeding full speed ahead with plans to begin matriculating students as early as October 2002."
Level 1 provisional licensure is the second step in the Florida licensure progression, with the next step being Level 2 and then finally Regular licensure. "Palmer will work with the Florida Commission to achieve subsequent licensure levels on a timely basis," added Douglas Hoyle, Ph.D., executive assistant to the Chancellor. "We will also be providing regular progress reports to the commission and expect site visits. This is all part of the normal licensure process in Florida."
While building the permanent campus in Port Orange, which is well along in planning, Palmer officials have plans in place to house the new college in temporary facilities on or near the land designated by the city of Port Orange for the permanent campus for the first nine to 12 months of operation.
According to the current plan, permanent campus facilities will be available for use by the summer of 2003.
"We are tremendously excited to have achieved this licensure milestone," said Palmer President Guy F. Riekeman, D.C. "We are pleased to be well on our way to opening our doors in Port Orange by October 2002 and building a chiropractic campus from the ground up. We’re also proud of the fact that this college will be intensely educating students in the latest science, technique, clinical, business management principles, and of course the core principles of chiropractic."
Prospective students can call Admissions at 800-722-3648
Superstar Arnold Schwarzenegger Delivers Enthusiastic Statement Of Support For Chiropractic At ICA Symposium
- Monday, January 28, 2002 by garyfarr
ICA again was honored to host bodybuilding champion, world-renowned film star and friend of chiropractic, Arnold Schwarzenegger as its featured speaker at the 9th Annual Symposium on Natural Fitness held March 2-3, 2001 in Columbus, Ohio. Greeted by an enthusiastic assembly of over 200 DCs, students, and friends of chiropractic, Mr. Schwarzenegger's presentation at the Symposium included an emphatic, enthusiastic and personal statement about chiropractic. A chiropractic patient for many years, Arnold congratulated ICA on its 75th anniversary of leadership in the profession and expressed his appreciation for ICA's ongoing presence at the Arnold Classic events each year.
Mr. Schwarzenegger told the gathering:
I am so thrilled to have you again here at The Arnold Classic, and to have the International Chiropractors Association hold meetings with us here each year for so many years. I want to tell you how much you mean to us, because you bring a lot to the Arnold Classic every year, by being a part of it, and because this is a profession that is one of the most noble and wonderful professions…It is truly one of the few professions that really helps people in a straightforward way with no monkey business, like some of the other professions promise to help, but this chiropractic is the real thing.
This year, Mr. Schwarzenegger also spoke about the role chiropractic has played in his movie career, detailing how he arranged for a chiropractor to be on the set of his new movie "Collateral Damage" and how this Doctor of Chiropractic worked all-hours (more) to take care of the actors and film crew, making it possible to continue safely and productively with heavy schedules and repeated exertion throughout the stressful production schedule. Mr. Schwarzenegger commented, "Eventually, you know, your body wipes out and you start getting injuries when you are tired and you don't take care of yourself, and you all know that. And this wonderful chiropractor came to the set about three times a week helping people work with her adjustments; I would see people leaving the trailer where she had her table, saying, 'I don't feel it any more, this feels really good, I can go back to work."
This unique event, sponsored by the Council on Fitness and Sports Health Science of the International Chiropractors Association for the ninth consecutive year in conjunction with The Arnold Schwarzenegger Bodybuilding Classic and Fitness Expo, brought together top authorities in sports chiropractic with celebrities from the fitness world for a weekend of education, inspiration and communication. The Arnold Schwarzenegger Classic and Fitness Weekend features a series of the world's most prestigious annual bodybuilding, fitness and martial arts competitions and is sanctioned by the International Federation of Body Building (IFBB). The Arnold Fitness Weekend is the largest fitness event outside of the Olympics and has been held in Columbus, Ohio for over the past 25 years.
The ICA Natural Fitness Symposium focuses on the close relationship between fitness and health, and brings together the sport of bodybuilding and chiropractic science to educate all participants on the value of natural health through exercise. Through clinical presentations and lectures combined with practical demonstrations, the Symposium provides the latest information available on the development of optimum performance in sports and training on injury prevention in the context of chiropractic care. This year's event, hosted by Arnold Schwarzenegger himself, included a multitude of fitness stars including bodybuilding champion and fitness author Mr. Bill Pearl, wellness leader and physical endurance record holder, Dr. Bob Goldman, and Dr. Tom Deters, Editor of Weider publication's worldwide exercise magazine Muscle and Fitness. (more) Arnold Schwarzenegger has been an enthusiastic and outspoken chiropractic patient for many years, and highlighted the importance of chiropractic care for himself and his family. Arnold told the group:
Chiropractic is about health and fitness. This is why I'm so excited to have the chiropractors here from all over the world each year, because you represent exactly the same thing. Chiropractic is about health and fitness. Chiropractic is about natural, preventive health care. What you are doing, and I have experienced this for the last 20 years myself on my own body, means that whenever I have a problem-or even if I don't have a problem-and I go to a chiropractor, my problems are gone for a long time.
And everyone understands what we're trying to do is not just promote the sport of bodybuilding, but fitness--health and fitness, for us, is everything in a naturally healthy lifestyle. So that's why it is so great for us to work together. As you know, the Arnold Classic is getting bigger every year. The Arnold Fitness Expo grew another 50% since last year, and we have over 1500 gymnasts from around the US and the world, along with martial artists and other athletes. So it's really great with you present because what the whole weekend really means is, let's bring everyone together that represents health and fitness. We don't care if it's someone that lifts 500 tons of weights a day to keep their bodies in shape, or if someone is a gymnast, or if someone gets bodies in shape by chiropractic. This is why I'm so excited to have the chiropractors here from all over the world each year, because Chiropractic is about health and fitness. Chiropractic is about natural, preventive health care. We all believe in the idea that health and fitness are fun, that it makes you happy, it makes you feel good, your whole outlook in life is totally different when you feel strong, when you feel healthy, when you feel secure with your health and fitness. I want to thank you all for being a part of this and it's great to have all of you with us.
Chiropractic offers athletes of all sports a natural, drug-free way to achieve peak performance, prevent injury and maintain a rigorous training schedule. Chiropractic participation in the Arnold Schwarzenegger Fitness Weekend and Bodybuilding Classic highlights the positive and rapidly growing relationship between athletics, fitness and chiropractic. Plans for the gala 10th Year Anniversary Symposium with Arnold March 1-3, 2002 include increased national and international attendance. For more news about this and other ICA Fitness Council programs, visit ICA's website at www.chiropractic.org.
Exercise Is Natural Reliever For Chronic Low Back Pain
- Monday, January 28, 2002 by garyfarr
May 31, 2000 - People with chronic pain can peddle away some of their discomfort, according to a new study by a Medical College of Wisconsin researcher at the VA Medical Center in Milwaukee. Martin Hoffman, M.D., professor of physical medicine and rehabilitation, has found that people with chronic low back pain reduce their pain perception for up to thirty minutes after a moderate workout on an exercise bike.
Dr. Hoffman will be presenting his findings at the annual meeting of the American College of Sports Medicine in Indianapolis on May 31. In Dr. Hoffman's study, eight people who have suffered from chronic low back pain for an average of seven years, reported feeling significantly less pain on a standard measure of pain perception after riding an exercise bike for 25 minutes, compared with before.
The subjects reported their pain level on a subjective scale in response to having a weighted plastic edge placed on their non-dominant index finger for two minutes. They indicated their pain level every 10 seconds by marking a 10-centimeter scale. The end points of the scale were "No pain" and "The worst possible pain imaginable." He did not specifically measure the subjects' back pain, because such pain is well known to be variable.
Dr. Hoffman isn't certain what the basis of the reduction in pain perception is, but he is sure that it does involve the whole body. "The exercise is done with the legs, and we found the pain alteration to affect the finger, so it's pretty safe to say it's a systemic effect. Therefore we expect the site of any chronic pain to be affected to some degree as well. If people would exercise a little bit they would likely get some relief from their pain," says Dr. Hoffman.
If someone with chronic pain doesn't have an exercise bike, not to worry, says Dr. Hoffman. "For the average person with chronic pain the advice I would give is if they can walk, and they have a place to do that, that would be ideal. If they don't live in an area where it's safe to walk or they don't like getting out in the cold or don't have a shopping mall or a treadmill, one of the indoor exercise devices would be an alternative," he says.
People with spinal nerve damage might not be able to use an exercise bike. They might find a recumbent bike or a stair-stepping machine more tolerable, says Dr. Hoffman. None of the participants in this study had such nerve damage.
Dr. Hoffman believes that a regular aerobic exercise program would also benefit people suffering from chronic back pain. There is evidence of such benefit for people with other painful disorders. "There have been a couple of studies with people with fibromyalgia that have suggested that a regular exercise program may have some benefit," he says.
Dr. Hoffman's research, which was done with his colleagues, Philip S. Clifford, Ph.D, professor of anesthesiology and physiology and S.P. MacKenzie, physical medicine and rehabilitation resident, was supported by the Physical Medicine Research Foundation's Woodbridge Grants and Awards Program and the Veterans Affairs Medical Research Service.
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Department of Health and Human Services Policy Letter Spells Major Victory for ACA and DCs
- Tuesday, February 26, 2002 by 
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