August 2004

V.A. release notes need for 'referral'

Ignores care for subluxation correction

In 2003, several chiropractic members of the VA Chiropractic Advisory Committee (CAC) voted in favor of a gatekeeper system that would require a patient to have a "consultation" from a primary care provider before seeing a chiropractor.

The only two members to vote against the recommendation and argue for direct access were Leona Fischer, DC, of the World Chiropractic Alliance (WCA) and Michael McLean, DC, of the International Chiropractors Association. Both members also fought for the inclusion of a specific reference to subluxation correction.

The vote for a gatekeeper by the three members affiliated with the American Chiropractic Association ‑‑ Cynthia Vaughn, DC, Rick McMichael, DC, and Reed C. Phillips ‑‑ and Charles DuVall, DC, president of the National Association of Chiropractic Medicine, caused an uproar throughout the profession.

The ACA quickly tried to convince DCs that their committee members didn't really vote for a gatekeeper system since the actual word used in the recommendation was "consultation," not "referral."

However, a recent press release issued by the Department of Veterans Affairs was less than encouraging about the true meaning of "consultation."

According to the release, DCs will offer "patient evaluations and chiropractic care for neuromusculoskeletal conditions," but only "in consultation with VA primary care providers."

An indication of the potential difficulties that system might pose, however, was found in the press release's explanation that "eligible veterans in areas distant from these locations will also be able to receive chiropractic care through VA's outpatient fee‑basis program after a referral by their primary care provider, and prior authorization by the department" (emphasis added).

On the positive side, the release also contained a quote from VA Secretary Anthony Principi: "Today, VA makes another significant improvement to the world‑class health care we provide for eligible veterans. Veterans who will benefit from chiropractic services will now have the opportunity to receive chiropractic care to restore them to good health."

Upon receiving the VA press release, the WCA announced that it would encourage doctors to apply for positions at the selected facilities in order to provide subluxation correction to patients and to help educate VA personnel about the role of chiropractic in health care.

VA locations where chiropractic care will be provided include: Togus, ME; West Haven/Newington, CT; Buffalo and the Bronx, NY; Butler, PA; Martinsburg, WV; Salisbury, NC; Augusta, GA; Tampa and Miami, FL; Mountain Home, TN; Columbus, OH; Danville, IL; Iron Mountain, MI; Kansas City, MO; Jackson, MS; San Antonio, Temple, and Dallas, TX; Albuquerque, NM; Phoenix, AZ; Fort Harrison, MT; Seattle, WA; Martinez and Los Angeles, CA; and Sioux Falls, SD.

Chiropractors seeking employment or wishing to provide contract services to veterans should call the Human Resources office of any of the above facilities. Some VA positions may be advertised at http://www.vacareers.com.