Medicare Reform is a Public Health Imperative

Medicare Reform is a Public Health Imperative

President's Message

Author: David Herd, DC/Wednesday, March 2, 2016/Categories: March 2016

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By David Herd, DC

Good public health policy saves lives and saves money by building healthier communities. Prevention, wellness, early disease detection, ease of access and conservative intervention are fundamental elements of sound public health. Removing barriers to access and utilization of chiropractic services by American senior citizens is a public health imperative. 

Every day, 11,000 new beneficiaries become eligible for Medicare. Many of our seniors suffer with chronic disease, including musculoskeletal conditions. Chronic musculoskeletal disease results in decreased activity and the development of other systemic illnesses. Some chronic conditions result from uninformed lifestyle choices. There is a resulting heavy financial and quality of life burden placed on the society pledged to provide their care. These challenges are worsened by the growing national shortage of primary care physicians.

Chiropractic physicians are the most underutilized physician group under Medicare. This is in spite of our conservative care delivering high value, safe treatment and high patient satisfaction. The reason we are underutilized is simple. We are defined as a single service provider covered to treat a single condition. This limitation does not affect our scope of practice; it merely places an undue burden on chiropractic Medicare patients to pay out of pocket for all our other chiropractic services. Patients are often financially forced out of our offices to more expensive providers for more costly and invasive procedures that are paid for by Medicare. This wastes our nation’s health care resources and negatively affects our overall public health.

Our greatest professional opportunity to influence public health at this time is to successfully expand access to our conservative approach to patient care of the whole person for the Medicare population. Back and neck pain have always been gateways to our offices, but we effectively handle many other conditions.

The United States Bone and Joint Initiative publication, “The Burden of Musculoskeletal Diseases in the United States,” quantifies the extent of musculoskeletal complaints for all population groups. The numbers are staggering. Among our senior population, at least 40 percent have chronic joint pain, 47 percent have arthritis, 14 percent have neck pain, and 30 percent have back pain. Limitations of activities of daily living are reported by 13 percent in the 65-74 age group and by 22 percent age 75 and above. Total expenditures for musculoskeletal disease in Americans 65 and older reached $294 billion in 2011. Medicare paid chiropractic claims of only $496 million in 2012 or .16 percent of overall musculoskeletal care costs. The system can be improved.

Your ACA, since its inception, has been engaged in working to improve public health policy. Our original bylaws, approved in June 1964, established ACA’s public health committee, chaired by Joseph Janse, DC. Wellness, prevention, hygiene, nutrition and fitness for all ages are some of the themes of public health policy that we have championed over the years. In many ways, chiropractic physicians are the original lifestyle coaches.

Society can no longer easily absorb the economic impact of musculoskeletal disease in its aging population. There are more seniors, and they are living longer. Increased chiropractic utilization by Medicare beneficiaries will improve the cost trajectory of musculoskeletal care for our seniors individually and the Medicare system as a whole. Increased chiropractic utilization by our seniors will also increase their activity levels, independence and systemic health, thereby decreasing other health expenses.

Secondary benefits to the U.S. health system will include the creation of increased opportunities for chiropractic physicians to enter into the evolving collaborative and integrative models of care. These opportunities are now severely limited by our poor levels of reimbursement. Over time, we should also experience changes in coverage in other payment systems, both federal and private, which have limited reimbursement models based on the existing Medicare statute.

Finally, our ability to collect data on our treatment of conditions other than back and neck pain will be enhanced by equal Medicare coverage.

ACA is leading the fight for Medicare parity for chiropractic patients. You can personally contribute to the effort by supporting the National Chiropractic Legal Action Fund, NCLAF, and having everyone you know sign the Medicare Equality Petition. Simply go to

Let’s work together to make healthier, more productive lives for the American people. (ACA Vision 2023.) 

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