September 2006

CCGPP draft widely rejected

Chiropractic organizations in 21 states have already voted to ask that the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) withdraw its flawed "Best Practices Lower Back Draft Document," according to a survey taken by the Wisconsin Chiropractic Association. Another two states have said they will support it only if significant changes are made. As of mid‑August, not a single state organization has voted to approve or endorse the document.

In addition, the World Chiropractic Alliance, the International Chiropractors Association, and the Federation of Straight Chiropractors and Organizations and have issued official statements rejecting the CCGPP attempt to foist its 'best practices' guidelines on the profession.

Among the state associations, the Wisconsin group has been the standard bearer for the campaign to disseminate information about the CCGPP document and alert other groups to the flaws and dangers inherent in it. In a single weekend, it sent out 10,000 faxes and 1,300 letters nationwide encouraging chiropractors to listen to the audio presentation on CCGPP posted on its website (www.wisconsinchiropractic.com).

The Wisconsin organization launched its campaign after leaders, including Executive Director Russ Leonard, expressed concern that "apathy on the part of states that have not taken a position may cause great harm to the profession." The group noted in its detailed analysis that adoption of the CCGPP document could result in the average chiropractor experiencing as much as a 30‑45% reduction in practice revenue.

Ironically, although some organizations faulted the document for failing to provide clinical validation for broad‑scope modalities, others criticized it for bias against subluxation‑based chiropractic. Opposition was clearly not divided along broad‑scope vs. focused‑scope lines but was widespread among all chiropractic schools of thought.

As the Wisconsin group pointed out, though, the state associations' input to the CCGPP might not have an impact on its decision about the document. "The CCGPP's only responsibility is to review the comments, they have no obligation to accept or act on any comment," the Wisconsin Chiropractic Association explained in a letter circulated on the Internet. "This effectively leaves the leadership of CCGPP to unilaterally decide the content of a document that will be utilized by insurance carriers to decide chiropractic reimbursement levels. The only thing that can stop this scenario is total rejection by the profession (at least 40‑45 states)."

Richard Schmitt, DC, vice president of the Maryland Chiropractic Association and chairman of the committee that evaluated and responded to the CCGPP draft guideline noted: "I believe that the CCGPP guidelines in their present form may be used as a tool to hinder our ability to practice and if abused by the insurance industry, will create a serious problem for individual practitioners and their patients." He urged other state organizations to review and reject it.

New York Chiropractic Council President Peter H. Morgan, DC, added a similar encouragement, telling other boards: "The Board of the New York Chiropractic Council urges your organization to do a thorough review of this draft of the document. Our organization feels it is flawed in its design and does not reflect the way the majority of chiropractors practice in the United States."

In addition to criticism about the document itself, many chiropractors are turning the spotlight on the process, and the people, involved in its development.

Criticism was also leveled at the CCGPP's decision to permit only 60 days to review and provide input into the document, which was withdrawn from the CCGPP website after the designated review period. (Note: Because the World Chiropractic Alliance feels it is necessary for doctors to read the document in order to judge the validity of the criticism leveled against it, it is making the draft available at www.worldchiropracticalliance.org/ccgpp)

In his publisher's column in the August issue of The Chiropractic Journal, World Chiropractic Alliance President Terry A. Rondberg, DC, compared the new document to its predecessor, the Mercy guidelines. "Our history with the Mercy Consensus Conference was disastrous and the resulting document was rejected by nearly every national and state chiropractic organization ‑‑ including the groups that initially supported it!" he stated. "It hurt nearly all DCs financially and was embraced only by the insurance industry and some power‑hungry board members who used it as a weapon against subluxation‑based chiropractors."

He urged all state organizations to review the document and voice their objections. "As Russ Leonard in Wisconsin pointed out, it's sink‑or‑swim time. If state organizations don't band together and reject the CCGPP document with near total agreement, we'll find our practices dominated by guidelines that are nothing more than a club for the insurance industry to bludgeon us with."