April 2003

WCA, Coalition to seek legislative solution to 'turf' problem

Will no longer help fund ACA lawsuit effort

In Nov. 1998, the ACA filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS), in hopes of ensuring that medical doctors, osteopaths and physical therapists could no longer be reimbursed for providing chiropractic care.

So far, more than $5 million has reportedly been spent on this lawsuit and on another suit against Trigon Blue Cross Blue Shield of Virginia, filed in 2000. Handling both suits is attorney George McAndrews, brother of Jerome McAndrews, D.C., national spokesperson for the group.

Yet, as the years have gone by with little or no progress on the lawsuit, many chiropractic leaders have begun looking for alternative solutions.

At a recent meeting between the founding members of the Chiropractic Coalition -- the International Chiropractors Association, Federation of Straight Chiropractors and Organizations and World Chiropractic Alliance -- a decision was made to seek legislative protection of chiropractic's 'turf.'

"The leaders of all three organizations have determined that the ACA's approach may be far more expensive and uncertain than lobbying for a law that will clearly give doctors of chiropractic the exclusive domain over subluxation correction," stated WCA president Terry A. Rondberg, D.C., who had previously supported the ACA's lawsuit, personally contributing more than $10,000 to the ACA's National Chiropractic Legal Action Fund (NCLAF).

The leaders of all three founding members were in complete agreement on the issue.

Dick Plummer, D.C., FSCO Chairman quickly threw his group's support behind the new approach. "Although we in the FSCO recognize the effort and resources that have been expended attempting to secure the rights of chiropractors through the courts to gain exclusive domain over subluxation correction and reimbursement for same we see that that course has serious limitations. For this reason we support the Coalition in a legislative course of action for redress in this matter."

"ICA enthusiastically supports the goal of securing the exclusive right of the doctor of chiropractic to 'identify and correct subluxations' under Medicare," said ICA President Dr. D.D. Humber. "But, if you want to secure this goal, consider what one senior Senator, who also happens to be a member of the Senate Finance Committee recently told ICA: 'Congress, not the courts makes national health care policy. If you want to make a permanent change, make it in the statute. Trying to do what you want to do in Medicare through the courts is like trying to tie up a monster with a rope of sand.' The opportunity to make a change in the statute on this point exists. Why not push with a united front to seize this vital goal through Congress, now?"

Dr. Rondberg added that the Coalition decision was not an attack on the ACA or an attempt to cause further conflict between the ACA and the other organizations."I was one of the top contributors to the ACA's fundraising effort, so the ACA can't accuse me of not trying to support its efforts. But, I have to think of what's best for the chiropractic profession, and it appears we're throwing our money down a bottomless pit with this lawsuit," he added. "The WCA therefore is in full accord with the Coalition's statement concerning the need to pursue legislation that will protect our unique role in health care."

The ever-increasing cost of the ACA lawsuit is seen as a major drawback to that approach. "In just a few short years five million dollars has been spent on this lawsuit," Matthew McCoy, D.C., editor of the Journal of Vertebral Subluxation Research observed. "This is half what the chiropractic profession has received from the federal government for research in over one hundred years of our existence. I can't help but think what five million dollars would have done to further our research efforts and establish our legitimacy." Dr. McCoy serves on the WCA Board of Directors.

Members of the Coalition will work jointly to introduce and generate congressional support for a bill specifying that doctors of chiropractic are the only health care providers licensed and trained to perform adjustments to correct vertebral subluxation, and barring federal programs such as Medicare from reimbursing non-D.C.s for that service.

Planning for this legislative effort began last year, during a meeting between various chiropractic organizations to discuss joint legislative actions. Although invited, the ACA refused to attend, saying its new official policy was to "forego" such cooperative efforts.

Coalition Statement on NCLAF

The Chiropractic Coalition shares the widespread concern for safeguarding the unique character of chiropractic, and for maintaining subluxation correction as the exclusive domain of doctors of chiropractic. It is therefore imperative that federally funded programs such as Medicare contain language that clearly states that medical doctors, osteopaths and physical therapists are not eligible to be reimbursed for providing subluxation correction services.

After reviewing the status and progress of the American Chiropractic Association's lawsuit against the Centers for Medicare and Medicaid Services (CMS), which seeks a judicial decision to clarify this issue, the Chiropractic Coalition has determined that securing a legislative remedy would be more effective and less costly to the profession.

While the Chiropractic Coalition is pleased to support the "spirit" of the ACA's lawsuit against the CMS - also known as the "S.O.S." or HCFA lawsuit -- it remains under an obligation to inform the profession that the lawsuit approach contains certain limitations. Knowledgeable political experts agree this judicial decision will have no impact that health policy is formulated by the legislature, not the courts. A judicial remedy is subject to re-interpretation or appeal and provides no permanent, guaranteed protection.

Further, a lawsuit is an extremely time-consuming and expensive tactic. The National Chiropractic Legal Action Fund (NCLAF), formed to fund the ACA lawsuit, has reportedly already cost the profession more than $5 million, according the ACA reports. More than 7,800 doctors, companies, organizations, and individuals have contributed to this fund - with one national regulatory board donating $200,000 -- and the ACA has stated that more money is needed to continue the process.

It is the opinion of the Chiropractic Coalition that this money that could be better spent on funding subluxation-based research, conducting public relations, engaging in national and international legislative efforts, and other much needed programs to protect and promote the chiropractic profession.

Therefore, the Chiropractic Coalition can no longer encourage doctors to provide additional contributions to the NCLAF. Instead, the Chiropractic Coalition, and its member organizations, will pursue legislation that will give chiropractors the exclusive right to perform, and be reimbursed for, subluxation correction under Federal programs.