January 2008

CCGPP vs. CCP

by Dr. Christopher Kent

The draft of the newest chapter of the "Best Practices" document released by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) contains statements and conclusions that could prove devastating to the chiropractic profession. In it, the CCGPP gives rogue regulatory boards the weapons they need to go after and sanction subluxation based chiropractors who provide this care, and third party payers the ammunition they need to deny reimbursement for subluxation care apart from NMS conditions.

The chapter, entitled "Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; And Conditions Of The Elderly, Children And Pregnant Women," makes it clear that, from the data the CCGPP members considered, there is not enough evidence to support the use of chiropractic care for patients who are not presenting with specific non musculoskeletal health issues. Shockingly, the CCGPP also ignored all case studies, regardless of how many patients were involved. It explained its decision only with the statement that "even though there are a large number of patients described in case reports, these reports can only provide evidence that patients with the conditions described have sought care from chiropractors; case reports cannot provide convincing evidence to support best practices."

It takes little imagination to see what state boards and other regulators will do with this," he warned. "In today's politically charged atmosphere, a board could easily target a particular class of doctors and charge them with endangering patients by providing care unsupported by research and disavowed by the CCGPP guidelines.

What's really going on? There is a well choreographed plan to sculpt the future of the profession. It casts chiropractic as a profession that uses crude manipulation for the short term symptomatic treatment of a narrow range of spinal pain syndromes. It involves either denying the very existence of vertebral subluxation, or at best downgrading it to a local mechanical lesion. The use of objective assessments is dismissed. Instead, care is based primarily on symptomatic response, without regard for x ray or neurofunctional changes. Of course, lifetime wellness care is unthinkable in this model.

Thankfully, DCs who focus on subluxation and wellness care have a resource to defend themselves: the Council on Chiropractic Practice (CCP) guideline. The guideline is a compilation of the best available evidence concerning the detection, management, and correction of vertebral subluxation. It serves as a tool to empower DCs with the information needed to develop more effective clinical strategies, and objectively assess functional and clinical outcomes. The document also provides chiropractors with the intellectual ammunition needed to defend their practice style when challenged by regulators, policy makers, and in court proceedings.

The chiropractic guideline document, "Vertebral Subluxation in Chiropractic Practice," produced by the CCP was reviewed by an independent research agency (ECRI) which is a Collaborating Center of the World Health Organization (WHO). Based on this review, it was accepted for inclusion in the National Guideline Clearinghouse (NGC), a public resource for evidence based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.

The CCP and its official published documents were accepted for inclusion in the Healthcare Standards Database and the printed version of the Healthcare Standards: Official Directory. Healthcare Standards (HCS) is a comprehensive list of published standards, guidelines recommendations, position papers, policy statements, technology assessments, and other authoritative documents. ECRI is the WHO's official health care standards and guidelines archive. HCS is used daily in legal and clinical settings by a wide variety of medical and legal professionals such as: risk managers, litigators, paralegals, legal nurse consultants, medical and legal librarians, patient safety officers, biomedical engineers, insurance carriers and more.

When challenged by regulators, policy makers, or in courtroom proceedings, where will you find the resources to defend your practice? If your vision of chiropractic embraces lifetime, subluxation based wellness care, you need CCP. The Council on Chiropractic clinical practice guidelines have been used to successfully support the ability of persons to receive chiropractic care for vertebral subluxations to improve function and quality of life. Care is based upon indicators of vertebral subluxation, not the presence of a short list of medical conditions.

To remain in the National Guideline Clearinghouse, guidelines must be updated every 5 years. The CCP update is due in 2008, and is proceeding largely through the efforts of volunteers. But now we need your help. Contribute generously to the Council on Chiropractic Practice (CCP) to continue to serve you by developing guidelines that are congruent with your vision of chiropractic. We look forward to having you join us, to preserve our sacred trust.

(Christopher Kent, DC, Esq., is president of the Council on Chiropractic Practice and a member of the Board of Directors of the World Chiropractic Alliance. He is the recipient of the "Chiropractic Researcher of the Year" award from both the WCA and the International Chiropractors Association, and the ICA's "Chiropractor of the Year" award. With Dr. Patrick Gentempo, Jr., Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor.)