ACA Missouri delegate Quinn James, DC, reached a milestone recently in his advocacy efforts on behalf of H.R. 3654, the Chiropractic Medicare Coverage Modernization Act: He managed to get the last of all eight of Missouri’s members of the U.S. House of Representatives to become cosponsors of the legislation. Missouri is the first state in the U.S. with multiple representatives to get all on board. Earlier this year, at ACA’s annual meeting, Dr. James (pictured below, at right, with Dr. F. Dow Bates) was awarded the ACA Political Action Committee’s F. Dow Bates PAC Bulldog Award recognizing his outstanding contributions.
ACA Blogs reached out to Dr. James to learn more about his effective approach for winning over cosponsors:
What is your message to elected officials when you discuss H.R. 3654?
I keep the messaging very simple: We are chiropractic physicians competing in a healthcare system for conditions that are already covered. We are not adding any new subscribers or adding any new conditions. We increase access for Medicare recipients and reduce costs by reducing opioid prescriptions, ER visits and surgery.
What type of evidence do you share?
I share information that reveals that one in three seniors with Medicare Part D are on an opioid script. The primary reason for an opioid script is back pain. I show them the cost savings analysis and utilization rates from Optum/UHC. I first point to utilization rates for chiropractic for nonsurgical spine pain, which is about 10 percent. I point out that the primary care physician (PCP), in comparison, has a 50 percent utilization rate. I then show them a breakdown of cost per episode for treatments provided by a doctor of chiropractic and the PCP. Chiropractic is much more cost-effective.
In addition, I show them the policy from UnitedHealthcare stating that they are waiving deductibles and copays for certain UHC plans for chiropractic. I then ask them why UHC would do this? We have a discussion about pocket-book economics and driving patients to the most effective form of care by making it more cost-effective to see a chiropractor. It has worked well, and they come to the conclusion quickly that if Medicare doesn’t cover an initial exam for the chiropractor, as well as the other services we are licensed to perform, they seek care elsewhere that costs Medicare more.
- I show them publications from the Joint Commission, the Journal of the American Medical Association, and the American College of Physicians regarding best practices and treatment guidelines.
- I share the letter that was signed by 37 state attorneys general urging health insurance companies to provide nonpharmacological treatment options for patients.
- I have slides from the Missouri Department of Social Services that show cost of emergency room discharges associated with opioid abuse.
- I use the article from Military.com that shows the military is moving to add services provided by chiropractic physicians for Tricare recipients. If a representative cosponsored Tricare, H.R. 344, I love to show them this to let them know they made a good decision on that issue. This helps to bolster your position that they now need to make the same good decision for Medicare and H.R. 3654. It also helps to establish the fact that Medicare recipients are one of the only groups that do not have full access to their chiropractor.
Does chiropractic’s scope of practice come up?
Not typically, but when it does I try not to get into specifics regarding what we can and can't do. I tell them that states have the right to determine scope of the provider, and we should be able to practice up to that full scope, as allowed by our state.
What do you think is the secret to your success?
I really just try to have a conversation and see where it leads. Some members of Congress are very sensitive to the opioid issue, some are fiscal hawks, some care about Medicare patients getting access to care. I do my homework before the meeting and see what types of legislation they have sponsored in the past and work that in when I can. Knowing their previous occupation and biography can help.
I also have a list of chiropractors in their district that are my key contacts. I make sure to reference the chiropractors in their district in the conversation, especially if the chiropractor sent a letter to the congressman and I am not in their district. I tell them that I have been selected to represent the chiropractors from across Missouri on this issue.
I also try to send them an occasional email thanking them for their support on other issues, so it lets them know I am keeping up with other subjects. For example, when a key member of Congress cosponsored opioid legislation, I sent a thank you letter and explained how chiropractic physicians can be part of the solution. When they passed the Paycheck Protection Program (PPP) program, I shared updates with my elected officials to let them know how my small business was doing. I provided positive feedback and let them know how important the PPP program was for my small business. I explained that I was able to keep all my employees fully paid with no layoffs.
Do you think this approach can work in other places?
Yes, I believe other states can duplicate this success using the information I have used. Including some data that is specific to their state would be an added benefit. I was able to go to the Missouri Department of Insurance to get some valuable information. There is no one-size-fits-all approach, but it is generally the same information.
Any advice to others who would like to replicate your success in their state?
It really just takes persistence. I prefer to meet in person with each representative or their staff, but I have also had success through emails. Find the connections or key contacts that get you in the door and present our case. Our case is compelling and will sell itself once you get in front of the legislators.
What about Missouri's senators? Are they on board?
It has taken some time, but I have been able to form a good relationship with Sen. Roy Blunt's office. After a couple meetings in Washington, D.C. and locally in St. Louis, my persistence paid off. I have now been able to meet with Sen. Blunt’s healthcare liaison, military liaison, and legislative director. They have said they would cosponsor a Senate Medicare companion bill when it is introduced. Having strong relationships in the Missouri State Legislature helped. I asked for personal introductions and that gives me credibility.
Sen. Josh Hawley has been more difficult to track down. Interestingly enough, he was Missouri’s attorney general before becoming our senator. He signed the letter to AHIP urging health insurance companies to cover nonpharmacological treatment to lessen opioids use. I use this every time I meet with his staff. At our last meeting in January, his healthcare liaison stated this it was the best meeting he ever had with a constituent. We made a compelling case for being fully included in Medicare. I have also invited him to tour Logan University in St. Louis and offered to drive to Kansas City to take him on a tour of Cleveland University.
How long have you been involved in advocacy?
I have served on the Missouri Chiropractic Physician’s Association Legislative Committee for more than 17 years. I have been directly involved in passing multiple pro-chiropractic laws in Missouri. As part of this work, I have had to get out of my comfort zone and testify before committees in the Missouri House and Senate.
Have you continued your advocacy efforts during the COVID-19 outbreak?
Yes. This is important to our profession and thus to me personally. This pandemic has only energized me to do more. When I saw that Florida and Pennsylvania had caught up with Missouri (me) at seven cosponsors, it motivated me to get the eighth for Missouri and close out our state. We can't let this outbreak divert our attention from our goals. There is no better time to advocate for chiropractic physicians’ full inclusion in Medicare. This COVID-19 outbreak showed that our scope was being restricted by antiquated laws.