March 2003
TRIAD and NCMIC still won't let go of
Mercy
by Dr. Terry A. Rondberg
In a democracy, when a law or policy is
overwhelmingly rejected by the citizenry, that law or policy is overturned
and made null and void.
Apparently, that isn't the case in
chiropractic.
After a small band of self-appointed
"leaders" passed what was, in effect, the "law" of
chiropractic standards -- the Mercy Guidelines -- the "citizens"
of our profession overwhelmingly rejected the document. In fact, Mercy was
rejected by almost every chiropractic organization on national,
state and local levels, including the Congress of Chiropractic
State Associations, which initially sponsored the Mercy Conference.
The list of organizations and state
boards that rejected or withdrew their endorsement of Mercy is too long to
include here (you can read it on the WCA website, at
www.worldchiropracticalliance.org/positions/mercy.htm). The list includes
the WCA,
ICA
,
FSCO, and state organizations from
Alabama
to
Washington
.
The National Association of Chiropractic Attorneys voiced concerns about
the document, and refused to take any official stand on it.
The organizations were reflecting the
needs and desires of field doctors (as they are supposed to do!). Most
practicing D.C.s knew from experience how harmful these pseudo-medical
guidelines were. As Jason Haas, D.C., put it in an article for The
American Journal of Clinical Chiropractic, "Our Chiropractic
market share has drastically reduced since insurance companies and IMEs
began in 1992 to use these 'ACA' guidelines." ("A CALL TO
ACTION: Use Your Voice or Lose Your Freedom," April 2002.)
The problems associated with Mercy
became so obvious that they were pulled from the National Guideline
Clearinghouse (NGC), a comprehensive database of evidence-based clinical
practice guidelines and related documents produced by the Agency for
Healthcare Research and Quality (AHRQ).
The problems associated with Mercy
became so obvious that they were pulled from the National Guideline
Clearinghouse, a comprehensive database of evidence-based clinical
practice guidelines and related documents produced by the Agency for
Healthcare Research and Quality.
Considering you'd be hard pressed to
find a dozen doctors who actually support the Mercy guidelines -- not
counting the people who developed them -- you'd think the document would
be pretty much dead in the water, an experiment in insurance industry
appeasement that failed miserably.
Yet, Triad Healthcare, Inc., the
controversial healthcare provider company owned by NCMIC Group, actually
uses and promotes the document and demands compliance with it for
imaging.
Triad's user manual specifically
states:
"TRIAD is in full accord with, and
promotes the parameters for, the imaging utilization guidelines published
in the Guidelines for Chiropractic Quality Assurance and Practice
Parameters (
Aspen
,
1993). Compliance will be expected. Clinical indications for imaging
should be thoroughly documented in the case record."
This brings up two questions:
1) Why would NCMIC, which is TRIAD's
parent company, promote a document that has been so soundly rejected by
the chiropractic profession? There is no possible justification for any
chiropractic company to continue promoting and supporting a document that
has been found to be detrimental to our profession.
2) Why would any chiropractor want to
support a company that promotes or demands compliance with any part of
Mercy?
I've often quoted the line attributed
to Ayn Rand that "It is a moral crime to give money to support ideas
with which you disagree ... It is a moral crime to give money to support
your own destroyers," because it is a key to the survival of
chiropractic. If we support those whose policies are detrimental to our
profession, we are directly contributing to our own destruction.
Of course, chiropractic is not a
democracy since it (thankfully) does not have an official governing body.
But companies that rely on our profession for their revenue should at the
very least respect the wishes of the majority of the profession and not
take action that could be harmful to it. And the majority of chiropractors
have made it clear that they do not support or endorse the Mercy
Guidelines.
Do the owners and leaders of Triad and
NCMIC -- including people like Drs. Louis Sportelli, Jerome McAndrews,
Michael D. Pedigo, and Arnold E. Cianciulli -- think they are better
judges of what's good for chiropractic than thousands of practicing D.C.s
across the country?
At first, it might appear that this
support of Mercy affects only those doctors who are part of the TRIAD
network. But the fact is, any doctor who is insured by NCMIC may be
a victim of the company's pro-Mercy stance.
After all, if you are sued and an IME
stands up in court and says your care did not meet Mercy's standard of
"medical necessity," can you really expect NCMIC lawyers to
argue that the Mercy standard isn't valid? How can they? All the
plaintiff's attorney would have to do is ask, "Doesn't NCMIC's
subsidiary, TRIAD, promote and use Mercy?" When your lawyer was
forced to sputter an affirmative answer, the case would be closed -- you'd
lose!
Isn't it time we "repealed"
Mercy for good? And isn't it time to stop rewarding companies that put
their own interests before that of our profession?
