President Clinton signed the Veteran's Millennium Health Care Act (HR
2116) into law on November 30, 1999. This legislation requires the
Veterans Administration (VA) to develop a policy on chiropractic care
within 120 days.
Chiropractic in the United States
There are two major schools of thought in the chiropractic
profession. The first considers chiropractic to be a limited medical
specialty for the treatment of certain musculoskeletal disorders.
Proponents of this position embrace a broad array of therapeutic
interventions including manipulation and physical therapy modalities.
This necessarily encroaches on the practice of medicine and physical
therapy.
The second school of thought is committed to positioning chiropractic
as a separate and distinct discipline in the healing arts, which does
not duplicate existing medical services. It is directed toward the
correction of vertebral subluxations, which interfere with the function
of the nervous system.
Chiropractic in Medicare
Chiropractic has been included as a Medicare benefit for over 25
years. 42 USC 1395x (5)
provides for chiropractic services limited to manual correction of
spinal subluxations. The Medicare benefit does not include physical
therapy services. The only "condition" covered is spinal
subluxation.
This position is consistent with the school of thought which
positions chiropractic as a separate and distinct profession.
Chiropractic in the VA
The Chiropractic Health Care Demonstration project, created by the
1995 National Defense Authorization Act, attempts to position
chiropractic as a treatment for neuromusculoskeletal conditions, and
embraces a broad scope of therapeutic interventions. Many of these
services, particularly physical therapy modalities, are already
available through existing providers.
Furthermore, the Demonstration Project employs obsolete clinical
practice guidelines which include expensive and/or questionable
procedures. These include homeopathy, acupuncture, and passive physical
therapy modalities.
The Demonstration Project also inappropriately excluded persons under
17 years of age, and those who were pregnant.
Recommendation
Our recommendation is that the policy promulgated by the VA provide
for the following:
1. Chiropractic examination and adjustment to correct
vertebral subluxations.
Rationale: Physical therapy and
rehabilitation services are already available within the VA system;
chiropractic examination and adjustment to correct vertebral
subluxations are not. This provides consistency with the other existing
Federal program, is the more cost-effective approach, and satisfies
legislative intent.
2. Direct access to chiropractic care.
Rationale: Only a chiropractor is qualified
to determine the appropriateness of chiropractic care. Direct access
would also eliminate the costs associated with a screening process by
other providers.
3. Adoption of Council on Chiropractic Practice Clinical
Practice Guideline Number 1 -- Vertebral Subluxation in Chiropractic
Practice.
Rationale: This evidence-based guideline is
current, and was distributed to US chiropractors in 1999. It was
produced by an interdisciplinary expert panel, and underwent peer review
by 195 chiropractors in 12 countries. The Guideline is included in the
AHCPR National Guideline Clearinghouse .
The World Chiropractic Alliance
The World Chiropractic Alliance (WCA) is an international, non-profit
professional membership organization. The WCA is concerned with health
promotion, wellness, and quality of life issues. It is committed to
positioning chiropractic as a separate and distinct discipline in the
healing arts. WCA's vision of chiropractic is directed toward the
correction of vertebral subluxations, which interfere with the function
of the nervous system. WCA was accredited as an NGO (non-governmental
organization) by the Department of Public Information of the United
Nations in late 1998. The World Chiropractic Alliance urges the
Veteran's Administration to promulgate a policy which provides for
chiropractic care to correct vertebral subluxations.
