By David A. Herd, DC
The chiropractic profession has a rich philosophical tradition of vitalism, holism and naturalism. These traditions have resulted in a whole-person approach to patient care, including health promotion, disease prevention and therapeutic conservatism, which underscore even our management of active conditions. ACA has a modern Wellness Model policy available on our website. Our model fully describes the roles and responsibilities chiropractic physicians should play in appropriate wellness-centered care. See www.acatoday.org/About/Public-Policies.
The health care system as a whole is embracing wellness and prevention as never before as our population ages and the costs of caring for preventable and lifestyle-related diseases place ever increasing demands on society’s resources. Young people are more interested in maintaining their health and activity levels in anticipation of living longer. Insurers are providing premium rebates for those who join fitness centers and have annual physicals. Higher deductibles and co-pays are stimulating Americans to take more active roles in their own health, well-being and therapeutic choices.
The Affordable Care Act expanded the list of free preventive services that Medicare beneficiaries may receive in order to increase the health of our seniors and lower costs to the system. Many of the free preventive services available under Medicare fall within the scope of practice of chiropractic physicians in most states.
These preventive services would include screenings aimed at alcohol misuse, bone-mass measurements, cardiovascular disease, depression, diabetes, tobacco use and more. I am sure you noticed upon performing your 2015 attestation that many of the meaningful use quality measures involve these screenings. I am also sure that many of you have provided or ordered these screenings for your at-risk Medicare patients in spite of coverage issues.
One of the most commonly used preventive services in the Medicare system is the annual wellness visit (AWV). In 2013, the AWV service was used by 3.5 million Medicare beneficiaries. In 2015, nearly 9 million beneficiaries accessed this free service. The AWV is a level three E&M service. The first-year welcome visit reimburses $172 on average. Subsequent yearly AWVs average $111 across the country. Roughly twice as much was spent on this one service than on all chiropractic care under Medicare in 2015. The Centers for Medicare & Medicaid Services (CMS) estimated on Feb. 8, 2016, that 39.2 million beneficiaries took advantage of at least one free preventive service in 2015. Chiropractic patients should be allowed coverage for these services when provided by their physician of choice.
In spite of our long history as wellness providers, our training, our competencies as tested by our boards, the scopes of our present licensure and CMS’s own meaningful use standards, preventive services provided by chiropractic physicians under Medicare are not considered covered services and are not reimbursed. This exclusion is not beneficial to our patients or the Medicare program as a whole.
The first step in correcting this inequity is amending the Medicare law to correct the flawed definition of chiropractors as physicians. If adopted, the amended definition proposed by ACA will do just that.
There are several ways you can join the fight to amend the Medicare law. Have your patients of all ages sign the National Medicare Equality Petition (www.acatoday.org/equality/doctors) and support NCLAF (see cover wrap). Let’s stand together for the wellness of our Medicare patients.